What causes it?
Usually a blood vessel presses on the trigeminal nerve where it leaves the brain, wearing down its insulation and causing pain signals. The pain is brief, sharp and repetitive, in the nerve's territory. MRI is done to see the vessel–nerve contact and to rule out other causes.
Medication first
The first treatment is medication (such as carbamazepine), which controls the pain in many patients. When medication loses its effect, causes side effects or is not enough, procedures are discussed.
Microvascular decompression (MVD) and alternatives
MVD is an operation that moves the vessel away from the nerve and places a small protective cushion; in suitable patients it gives long-term relief while preserving facial sensation. Less invasive alternatives include percutaneous procedures (radiofrequency, balloon) and radiosurgery (Gamma Knife); the choice depends on age, condition and preferences.
Which treatment for whom?
MVD is often preferred in younger, healthy patients with clear vessel–nerve contact; percutaneous procedures or Gamma Knife are options for those who are not candidates for open surgery. The decision is individual after MRI and evaluation.