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Trigeminal Neuralgia
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Trigeminal neuralgia is a condition of chronic pain in which there is inflammation of the trigeminal nerve, the nerve of the face that controls sensation of the face. Mild facial stimulation, such as brushing your teeth or putting on makeup can trigger jolts of severe pain.
The pain can be intermittent and triggered by touch or other triggers. It can also be insidious and can trigger a long term pain that lasts indefinitely. It affects women more often than it affects men and is more likely to happen in those greater than age 50. Even though there can be a long term pain, the pain isn't lifelong and there are treatments available that can control and stop the pain.
Symptoms of trigeminal neuralgia include twinges of pain from certain triggers, severe pain that feels like an electric shock, attacks of pain that occur from brushing the teeth, speaking, chewing or touching the face, pain lasting up to several seconds, chronic pain lasting longer than several weeks or months that can have breaks in the pain, pain affecting one side of the face or the other, a toothache-like pain, localized facial pain to a certain part of the face and pain that increases in intensity over time.
Trigeminal neuralgia is also called tic douloureux and involves an inflammation of the trigeminal nerve-one of the cranial nerves of the face. There are three branches to the trigeminal nerve called I, II and III. Any of these branches can be inflamed apart from the other branches. Inflammation is related to a contact between the nerve branch and a blood vessel that irritates the nerve and causes the pain.
Trigeminal neuralgia can occur due to the aging process, due to multiple sclerosis or related disorder, or due to idiopathic reasons. A tumor can press on the trigeminal nerve, causing pain.
There can be numerous triggers to causing the pain of trigeminal neuralgia, including stroking your face, shaving your face, eating, drinking, talking, brushing the teeth, applying makeup or having a breeze on your face.
You can diagnose trigeminal neuralgia by understanding the patterns of pain seen in the disease and noting the type of pain you find. Certain triggers can only cause trigeminal neuralgia so it makes sense to pay attention to the triggers that cause the pain.
Neurological examination can show the various triggers causing the pain. MRI can show if multiple sclerosis is the cause of the trigeminal neuralgia. There can be nerve conduction studies that can differentiate between trigeminal neuralgia and other nerve disorders. Trigeminal neuralgia only affects the pain fibers and the face does not droop nor are there muscle problems in the face.
The treatment of trigeminal neuralgia involves taking certain medications, including steroid medication and pain medications. Eventually, however, some people become unresponsive to medications or have side effects that make taking the medications intolerable. Certain medications can block the nerve function and are anticonvulsant medications like Tegretol, Dilantin and Neurontin. Doctors can switch between the various medications so that, when one medication doesn't work, another medication can take its place.
Muscle relaxants can work to ease the muscle pain from the trigeminal neuralgia. Pain medication can be narcotic pain medication, NSAIDs or Tylenol.
An alcohol injection can temporarily block the pain. It is injected into the branch of the trigeminal nerve that is affected by neuralgia. Repeated injections can be done as the alcohol injection doesn't last very long.
Glycerol injection can also be done. It uses a needle inserted into the base of your skull. A small amount of glycerol is injected into the trigeminal cistern of the brain, where it breaks off into three segments. Glycerol damages the trigeminal nerve and blocks the signals of pain. There is often numbness and tingling of the face with this procedure.
There are several surgical options for trigeminal neuralgia. Even with surgery, the pain can recur. Different surgical options include gamma knife radiosurgery that involves providing radiation to the base of the trigeminal nerve so that it blocks the nerve function. It involves a low side effect rate of five percent and can be repeated if the pain recurs. It is a completely painless procedure.
There is a procedure that involves removing the blood vessel that is pinching off the nerve. This is called microvascular compression. The blood vessel can also be relocated to a different position. The surgeon can place a pad between the nerve and the vessel so they don't go so close together. The nerve can also be severed in a procedure called a rhizotomy
Balloon compression uses a catheter with a balloon on the end. The balloon damages the nerve and blocks pain signals. There is some temporary numbness in the face. An electrical current can also be used to destroy nerve fibers using an electrical impulse. It uses heat to destroy the nerve. Numbness and tingling of the face happens in almost everyone who has the electrical current procedure.