Overview of Trigeminal Neuralgia

 

Trigeminal Neuralgia can be a very painful experience. We are honored that you would trust us with information on this condition and hope that you will find this information helpful. Below are some of the main questions individuals ask when they or a loved one has Trigeminal Neuralgia.

What is Trigeminal Neuralgia?

Trigeminal neuralgia is:

  • A rare, on-going condition that affects the trigeminal nerve in the face and causes severe pain.
  • A condition that can come on randomly, usually happens later in life, and is more common in women.
  • Also called tic douloureux (tik doh-la-roo), which means painful twitch.

The Trigeminal nerve is:

  • A cranial nerve in the skull that allows you to feel sensations and pain on your face. Nerves are like electrical fibers that keep the body and brain in communication.
  • Branched into three different nerves that reach the forehead, eyes, cheeks, nose, lips, jaw and chin.

Why Does This Happen? – Causes

Neuralgia means nerve pain. This nerve pain can be caused by many different reasons including:

  • A blood vessel, a small tube that carries blood from the heart, that is pushing on the trigeminal nerve causing the protective coat, myelin sheath, around the nerve to wear down
  • Multiple Sclerosis: a disease that affects the nerves inside the brain
  • Physical injury to the nerves of the face

What am I Feeling? – Symptoms

  • Severe pain on one side of the face
  • Pain that is said to be stabbing, burning, random or shocking
  • Pain that lasts for seconds to minutes
  • Pain that comes from or is triggered by touching the face, chewing and eating, talking, brushing teeth and other daily activities
  • Pain that usually lasts longer as more time goes by

How Do I Know if I Have Trigeminal Neuralgia? – Diagnosis

A meeting with a doctor is needed for a diagnosis. Scans, such as an MRI, and typical physical examinations are usually normal; thus, the doctor will diagnose based on the patient’s:

  • Description of the type, location, and triggers of the pain
  • Finding what branch of the trigeminal nerve is causing the pain
  • Test results
  • How the patient has been responding to medications if used

The diagnosis is important because it will lead to the best treatment that is possible. Trigeminal Neuralgia is often diagnosed incorrectly confused with dental problems, headache syndromes, temporal arteritis, sinusitis, and tumors of the brain or the face.

What Can Help? – Treatment

Treatment options include different medications and procedures.

Step One: Medications
The first step is using medications to treat trigeminal neuralgia.

  • Carbamazepine (Tegretol) – the best choice
  • Gabapentin (Neurontin)
  • Phenytoin (Dilantin)
  • Pregabalin (Lyrica)
  • Baclofen

Carbamazepine is the medication that is most often used to treat the pain because it is known to be the most effective. As time goes on, the medications may not treat the pain as it did before or more of the medication may be needed.

Step Two: Surgical Options
The most common surgical procedures are:

Microvascular Decompression
This surgery is considered the most effective option for treating Trigeminal Neuralgia. It involves:

  • Using general anesthesia, which causes the patient to temporarily lose consciousness or ‘go to sleep’.
  • Making a small cut behind the ear of the side of the face that has the pain.
  • Finding the trigeminal nerve through this cut.
  • Finding if there is a blood vessel pushing on the trigeminal nerve.
  • Putting a small pad in between the blood vessel and the trigeminal nerve it is pushing on. This pad will cause the pain to go away because the blood vessel will be pushing into the pad instead of the trigeminal nerve and the nerve will no longer be worn down.

The surgery lasts around 45 minutes and the patient typically stays in the hospital for 2 days after the surgery with additional recovery at home. This surgery has higher long-term success rates, rarely results in numbness, and has a low complication rate

Radiofrequency Lesion
This procedure is a minimally invasive treatment that involves:

  • Temporarily anesthetizing the patient
  • Inserting a needle through the cheek of the face, into the trigeminal ganglion. A ganglion is a cluster of nerves.
  • Burning of the nerve by the electrical current to make it lose feeling and be numb.

The nerve regrows in around half of the surgeries; therefore, repeat operations are common. This procedure is pain-free because the patient is put to sleep and it takes around 10 minutes. After this procedure, the patient goes to the recovery room for about 2 hours and then is free to go home. This procedure has the drawback of making the face numb (it feels like you’ve had a novocaine injection) unlike microvascular decompression.  But for older or medically ill patients, it is quick and safe.

Radiosurgery
This an outpatient procedure and involves:

  • Focusing small beams of radiation on the trigeminal nerve.
  • Causing a change in the nerve from the energy of radiation that leads to pain relief.
  • This option usually takes 6-8 weeks to for the pain to go away.

Other surgical treatments:

Balloon Compression
A procedure that places a balloon to compress or flatten part of the trigeminal nerve to stop pain transmission.
Glycerol Injection
A procedure that injects glycerol into the trigeminal ganglion to soothe the pain.

Am I A Good Candidate for Surgery?

There are three groups when deciding if surgery is a good option.

Group I: Surgery is an option because the patient is in good health and has the classic symptoms of Trigeminal Neuralgia – severe, sharp, stabbing, intermittent lightning-like pain on one side of the face that is triggered by brushing teeth, eating and other daily activities and has had some relief with medications.

Group II: Surgery is an option; however, the surgery may or may not result in pain relief. This group has some of the symptoms of Trigeminal Neuralgia, but usually has something else occurring that is unknown. This group has lower success rates than group one.

Group III: Surgery is not an option due to atypical symptoms. No operation can be done because it could lead to making the condition worse.

The patient should remember that being a good candidate for surgery does not mean the surgery will work and result in wanted pain relief. Additionally, there are always risks involved with surgeries and it is important to know them.

What Are Some Ways to Cope With Trigeminal Neuralgia?

The best way to cope with trigeminal neuralgia is to seek expert medical and surgical advice.  Beyond that:

Take Care of Yourself
It is always in an individual’s best interest to have a healthy, balanced diet, as well as exercise daily. In addition, getting plenty of sleep and finding time to relax is also important.

Interpersonal Relationships
Having strong relationships with friends and family is important in coping and recovering with a disease. They allow individuals to rely and lean on caring people that are there for them and can be at their side through the whole process. However, relationships can become hard when coping with a disease; thus, it may be a good idea to always look at other people’s point of view.

Support Groups
Being around others that are going through the same thing has a positive impact on patients. It allows them to connect and ask questions to someone that has experienced the same or similar things. Additionally, it is always good to talk to someone different than the people an individual sees everyday. To find support groups please refer to this website:   https://fpa-support.org/support-network/

Hobbies
Spending time doing the things an individual likes improves their well-being. These activities will relax the individual and give them a time to take a break from their day to day routines. If an individual does not currently have a hobby, they can look up activities in their community or search for ideas on the internet.

References:

·       https://emedicine.medscape.com/article/1873373-overview

·       http://multiple-sclerosis-research.blogspot.com/2011/08/trigeminal-neuralgia-if-you-have-had-it.html

·       https://www.mayoclinic.org/diseases-conditions/trigeminal-neuralgia/symptoms-causes/syc-20353344

·       http://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Trigeminal-Neuralgia

·       https://neurosurgery.ufl.edu/patient-care/diseases-conditions/trigeminal-neuralgia/

·       http://go.galegroup.com/ps/i.do?p=AONE&u=gain40375&id=GALE|A205906635&v=2.1&it=r&sid=ebsco

·       https://neurosurgery.ufl.edu/patient-care/diseases-conditions/trigeminal-neuralgia/

·       https://www.cdc.gov/features/copingwithstress/index.html

·       https://www.verywellmind.com/the-importance-of-hobbies-for-stress-relief-3144574

·       https://www.psychiatry.org/patients-families/warning-signs-of-mental-illness