Trigeminal neuralgia is a chronic pain disorder.  It is very rare.  It affects the trigeminal nerve or the fifth cranial nerve.  The trigeminal nerve has two nerves one for each side of the face.  The trigeminal nerve is in charge of transmitting touch and pain sensations from the face and the head.  There are three branches.  The ophthalmic branch which is in charge of the top portion of the head, such as the forehead.  The maxillary branch, middle of the face, including the cheeks and nostrils.  The mandibular branch or lower part of the face, lower lip and jaw area.  Trigeminal neuralgia usually only affects only one side of the face, but it can be bilateral.  Pain can be intense and affect normal everyday activities.  

Symptoms usually happen suddenly.  They are usually very intense in pain.  Pain attacks can last seconds up to two minutes long.  There can be moments of relief in pain, but pain attacks can last up to hours at a time.  Attacks occur regularly lasting days, weeks, or months.  People can become anxious in waiting for pain attacks to return.  Trigeminal neuralgia can cause numbness, tingling, burning, throbbing, or aching sensations.  Pain rarely occurs at night.  There are some triggers that can bring on pain from trigeminal neuralgia.  Triggers can include touching your face with shaving or applying makeup.  Eating, drinking, teeth brushing, flossing, talking, smiling, pressure to the face, or even a gust of wind on the face can be a trigger. 

There are two different types of trigeminal neuralgia.  Typical type 1 trigeminal neuralgia has painful episodes that are sharp, intense, and sporadic.  The pain feels like a burning sensation all over the face.  Painful episodes last a few seconds to a few minutes with pain free breaks in between the episodes.  Atypical type 2 trigeminal neuralgia is less painful, but is more widespread.  Pain seems to be more constant as opposed to coming and going in episodes.  Aches and pains are more persistent, and it can be hard to control symptoms in type 2.  

Trigeminal neuralgia can happen at any age, even infancy.  It is more common though in people over the age of 50.  It is more common in women than in men.  There are a few conditions that can cause trigeminal neuralgia.  A blood vessel pressing on the trigeminal nerve.  Nerve compression because of a tumor.  Multiple sclerosis can cause trigeminal neuralgia.  Arteriovenous malformation, when arteries and veins are tangled.  Injury to the trigeminal nerve can also cause trigeminal neuralgia.  Injury can occur from sinus surgery, oral surgery, stroke, or facial trauma.  Trigeminal neuralgia is not preventable.  You can avoid triggers to help prevent attacks or pain once triggers have been found. 

There are a lot of conditions that can cause face pain.  Making sure you are diagnosed correctly may start with your doctor eliminating other conditions that could be cause for your pain.  Your doctor will want to listen to your symptoms, where the pain is occuring, and what you are doing that brings on the pain to help identify triggers..  A neurological exam can be done during the diagnosing process.  Along with a neurological exam your doctor may want to do a reflex test to help diagnose the cause of your trigeminal neuralgia.  An MRI can also help to determine if the trigeminal neuralgia is caused by multiple sclerosis, or a tumor.  Most of the time it is ruling out other possibilities to get to the diagnosis of trigeminal neuralgia.  

Treatment is usually a combination of medications, surgery, and complementary therapies.  One of the main medications that can be used are anticonvulsant drugs.  Carbamazepine can be used to help ease pain.  Anticonvulsant drugs can cause adverse side effects such as dizziness, nausea, confusion, and drowsiness.  Finding the right dose can take a few times before you notice the medication helping ease your pain.  If after taking the medication for a few weeks if you notice no change in your symptoms you will want to contact your doctor to up your dosage.  Tricyclic antidepressants are a more common medication choice for type 2 trigeminal neuralgia.  Common over the counter pain medications like Advil or ibuprofen usually do not help with the sudden pain that is associated with trigeminal neuralgia.  In some cases people do feel that some opioid medications have shown effective in treatment, but this is rare.  Muscle relaxants or Botox injections can help block the sensory nerves. 

Surgery is another option in treatment for trigeminal neuralgia.  One type of surgery is a microvascular decompression.  This is when a surgeon will remove or relocate blood vessels that are in contact with the trigeminal root.  During this procedure your surgeon may also perform a neurectomy which is when they cut part of the trigeminal nerve away.  This surgery option has shown to reduce pain for many years.  In some cases after 10 years pain does come back.  Side effects of the surgery include decreased hearing, facial weakness, facial numbness, and stroke.  Another surgery option is a brain stereotactic radiosurgery.  This is when a surgeon will focus radiation to the root of the trigeminal root.  This can help reduce or eliminate pain.  Relief from this surgery usually takes a while to happen, it can take weeks or months for you to finally start getting relief.  This procedure is usually successful, but like the other option pain can still reoccur.  Facial numbness is common with this surgery and it can continue for months or years after the procedure was done.   Another option is a rhizotomy which is when the nerve fibers are destroyed to reduce pain and cause facial numbness.  Options for this are a glycerol injection, balloon compression, or radiofrequency thermal lesioning.  

Complementary treatments include things like low impact exercise, such as yoga or meditation.  Chiropractic treatment.  Creative visualization.  Aroma therapy, and acupuncture.  Biofeedback.  Vitamin therapy or nutritional therapy.  The success of these varies per person.  These types of treatments are not always helpful, but can help ease pain or anxiety in between episodes.  

 

 

 


Leave a Reply

Your email address will not be published. Required fields are marked *