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Background  Trigeminal Neuralgia (TN) is a chronic neurological disease that is strongly associated with neurovascular compression (NVC) of the trigeminal nerve near its root entry zone. The trigeminal nerve at the site of NVC has been extensively studied but limbic structures that are potentially involved in TN have not been adequately characterized. Specifically, the hippocampus is a stress-sensitive region which may be structurally impacted by chronic TN pain. As the center of the emotion-related network, the amygdala is closely related to stress regulation and may be associated with TN pain as well. The thalamus, which is involved in the trigeminal sensory pathway and nociception, may play a role in pain processing of TN. The objective of this study was to assess structural alterations in the trigeminal nerve and subregions of the hippocampus, amygdala, and thalamus in TN patients using ultra-high field MRI and examine quantitative differences in these structures compared with healthy controls.    Methods  Thirteen TN patients and 13 matched controls were scanned at 7-Tesla MRI with high resolution, T1-weighted imaging. Nerve cross sectional area (CSA) was measured and an automated algorithm was used to segment hippocampal, amygdaloid, and thalamic subregions. Nerve CSA and limbic structure subnuclei volumes were compared between TN patients and controls.    Results  CSA of the posterior cisternal nerve on the symptomatic side was smaller in patients (3.75 mm 2 ) compared with side-matched controls (5.77 mm 2 ,  p  = 0.006). In TN patients, basal subnucleus amygdala volume (0.347 mm 3 ) was reduced on the symptomatic side compared with controls (0.401 mm 3 ,  p  = 0.025) and the paralaminar subnucleus volume (0.04 mm 3 ) was also reduced on the symptomatic side compared with controls (0.05 mm 3 ,  p  = 0.009). The central lateral thalamic subnucleus was larger in TN patients on both the symptomatic side (0.033 mm 3 ) and asymptomatic side (0.035 mm 3 ), compared with the corresponding sides in controls (0.025 mm 3  on both sides,  p  = 0.048 and  p  = 0.003 respectively). The inferior and lateral pulvinar thalamic subnuclei were both reduced in TN patients on the symptomatic side (0.2 mm 3  and 0.17 mm 3  respectively) compared to controls (0.23 mm 3 ,  p  = 0.04 and 0.18 mm 3 ,  p  = 0.04 respectively). No significant findings were found in the hippocampal subfields analyzed.    Conclusions  These findings, generated through a highly sensitive 7 T MRI protocol, provide compelling support for the theory that TN neurobiology is a complex amalgamation of local structural changes within the trigeminal nerve and structural alterations in subnuclei of limbic structures directly and indirectly involved in nociception and pain processing.    Supplementary Information  The online version contains supplementary material available at 10.1186/s10194-021-01325-4.

the journal of headache and pain

Leveraging high-resolution 7-tesla MRI to derive quantitative metrics for the trigeminal nerve and subnuclei of limbic structures in trigeminal neuralgia