In the initial phase, the attacks are short and there is a long gap between them. Progressively the attacks tend to become longer, more severe and more frequent. There may be sudden disappearance of the attacks for a few days or months, but gradually these attack ‘Holidays’ also become rare and then disappear. In patients who are not treated in time, the attacks become almost continuous and the sufferer is reduced to a miserable person, begging for relief.

The diagnosis of TN is made on the basis of a good medical history. Usually, the description of pain and the patient’s severe agony while talking, typical facial contouring and defensive facial posturing to avoid an attack immediately give away the diagnosis. A good quality MRI with Trigeminal nerve sequences is the next step, primarily to rule out tumours. An MRI-demonstrable vessel compressing the nerve is helpful, but is not a pre-requisite for surgical decision. This is because, severe vascular compression does exist, demonstrable at surgery even when MRI does not show it.

In the initial phase of the disease, some medicines like Carbamazepine (Tegretol) and Gabapentin are useful. However, they are nerve-numbing medicines and act only for a short time. They do not treat the root-cause of the disease. At our Trigeminal neuralgia centre, we have been relieving these patients of pain, with a surgery known as Microvascular Decompression (MVD). This surgery is performed with a neurosurgical microscope, and if done in time and by an experienced team it gives excellent results in more than 95% of the patients. MVD surgery has a great potential to give a long-term relief from pain and may permanently cure the patients. More importantly, the patient can stop their brain-numbing anti-epileptic medicines.