Trigeminal Neuralgia

What is a Trigeminal Neuralgia ?

Trigeminal neuralgia is a condition that causes painful sensations on one side of the face, comparable to an electric shock. The trigeminal nerve, which transmits feeling from your face to your brain, is affected by this chronic pain syndrome. Even mild stimulation of your face, such as brushing your teeth or applying cosmetics, can cause terrible agony if you have trigeminal neuralgia.

You may encounter brief, mild bouts at first. However, trigeminal neuralgia can worsen over time, resulting in longer, more frequent bouts of excruciating pain. Trigeminal neuralgia is more common in women than in men, and it is more common in those over the age of 50.

Because there are so many treatment options for trigeminal neuralgia, it doesn’t have to mean you’re bound to a life of agony. Medications, injections, and surgery are usually useful in treating trigeminal neuralgia.

Symptoms :-

One or more of the following patterns may be present in trigeminal neuralgia symptoms:

• Pain that seems like an electric shock and is intense, shooting, or jabbing.
• Pain attacks that occur without warning or are caused by actions such as touching the face, chewing, speaking, or brushing one’s teeth.
• Pain that lasts anywhere from a few seconds to several minutes.
• Face spasms can cause a lot of pain.
• Multiple episodes that last days, weeks, months, or longer – some people go through periods where they don’t feel any discomfort.
• The trigeminal nerve supplies pain to the cheek, jaw, teeth, gums, lips, and, less commonly, the eye and forehead.
• One side of the face is affected at a time.
• Is the pain concentrated in one area or is it dispersed across a larger area?
• Pain that occurs during sleeping is uncommon.
• Over time, attacks become more regular and intense.

When should you see a doctor ?

Consult your doctor if you have persistent or recurring face pain that is not eased by over-the-counter pain medicines.

Causes

The function of the trigeminal nerve is interrupted in trigeminal neuralgia, commonly known as tic douloureux. Contact between a normal blood vessel — in this case, an artery or vein — and the trigeminal nerve at the base of your brain is usually the source of the problem. The nerve is irritated by this contact, which leads it to malfunction.

While blood vessel compression is one of the most common causes of trigeminal neuralgia, there are numerous more possibilities. Some may be linked to multiple sclerosis or another illness in which the myelin sheath that protects particular nerves is damaged. A tumour compressing the trigeminal nerve can also cause trigeminal neuralgia.

Trigeminal neuralgia can be caused by a brain lesion or other problems in some persons. Trigeminal neuralgia can also be caused by surgical damage, strokes, or facial trauma.

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Treatment:-

Medication is usually the first line of treatment for trigeminal neuralgia, and some patients don’t require any further treatment. Some persons with the illness, however, may cease responding to treatments or have unpleasant side effects over time. Injections or surgery are other trigeminal neuralgia therapy options for those folks.

Your doctor will treat the underlying problem if your condition is caused by anything else, such as multiple sclerosis.

Medications:-

Your doctor will most likely prescribe drugs to decrease or block the pain signals transmitted to your brain in order to treat trigeminal neuralgia.

Anticonvulsants:-

For trigeminal neuralgia, doctors typically prescribe carbamazepine (Tegretol, Carbatrol, and others), which has been demonstrated to be beneficial in treating the condition. Oxcarbazepine (Trileptal, Oxtellar XR), lamotrigine (Lamictal), valproate, and phenytoin are some of the other anticonvulsant medicines that can be used to treat trigeminal neuralgia (Dilantin, Phenytek, Cerebyx). Clonazepam (Klonopin), topiramate (Qsymia, Topamax, and others), pregabalin (Lyrica), and gabapentin (Neurontin, Gralise, Horizant) are some of the other medicines that may be utilised.

Your doctor may increase your dose or switch you to a different type of anticonvulsant if the one you’re taking starts to lose its effectiveness. Anticonvulsants can cause dizziness, disorientation, sleepiness, and nausea as side effects. Also, because carbamazepine can cause dangerous medication reactions in certain people, particularly those of Asian ancestry, genetic testing may be recommended before you begin taking it.

Antispasmodic agents:-

Baclofen (Gablofen, Lioresal, Ozobax) and other muscle relaxants can be taken alone or in conjunction with carbamazepine. Confusion, nausea, and drowsiness are all possible side effects.

Botox injections:-

OnabotulinumtoxinA (Botox) injections have been found in small studies to alleviate pain from trigeminal neuralgia in persons who are no longer aided by medicines. More research is needed, however, before this medication may be widely used for this illness.

Surgery

Trigeminal neuralgia surgery possibilities include:

Microvascular Decompression – To prevent the nerve from failing, this surgery includes repositioning or eliminating blood vessels that come into touch with the trigeminal root. Your doctor will make an incision behind the ear on the side of your pain during microvascular decompression. Your surgeon will next transfer any arteries that are in contact with the trigeminal nerve away from the nerve and implant a soft cushion between the nerve and the arteries through a small hole in your skull.

Your surgeon may remove a vein that is squeezing the nerve. If no arteries are pushing on the nerve, doctors may cut a portion of the trigeminal nerve (neurectomy) during the treatment.

Microvascular decompression can successfully eliminate or lessen discomfort for many years, however three out of ten persons will experience pain again after ten years. Reduced hearing, facial weakness, facial numbness, a stroke, and other problems are all possible side effects of microvascular decompression. The majority of patients who have this treatment don’t experience any face numbness afterward.

Brain stereotactic radiosurgery (Gamma knife)

A surgeon directs a concentrated dosage of radiation to the root of your trigeminal nerve during this treatment. The trigeminal nerve is damaged using radiation, which reduces or eliminates pain. It may take up to a month for relief to appear.

For the most part, brain stereotactic radiosurgery is effective in removing pain. However, like with any treatment, there is a chance of recurrence, which usually happens within 3 to 5 years. If the discomfort returns, the surgery might be repeated or a different procedure used. Facial numbness is a typical adverse effect of the surgery that can last for months or years.