Description

Trigeminal neuralgia (try-JEM-ih-nul nu-RAL-khuh) is a condition that causes intense pain similar to an electrical discharge in one side of the face. It affects the trigeminal nerve, which carries signals from the face to the brain. Even the light touch brushing your teeth or putting on makeup-may trigger a jolt of pain. Trigeminal neuralgia may be of long duration. This is known as a chronic pain condition.

People with trigeminal neuralgia can, in principle, the experience short, mild pain episodes. But the condition can worsen, causing long periods of pain that happen more often. It is more common in women and people over 50 years of age.

But trigeminal neuralgia, also known as tic douloureux, it does not mean to live a life of pain. Can usually be controlled with treatment.

Symptoms

Trigeminal Neuralgia symptoms may include one or more of these patterns:

  • Episodes of severe, shooting or jabbing pain that may feel like an electric shock.
  • Sudden episodes of pain, or pain caused by touching the face, chewing, speaking or brushing teeth.
  • Episodes of pain may last from a few seconds up to several minutes.
  • The pain that occurs with spasms of the face.
  • The episodes of pain that last for days, weeks, months, or longer. Some people have periods when they experience pain.
  • Pain in areas supplied by the trigeminal nerve. These areas include the cheek, jaw, teeth, gums, and lips. Less often the eye and forehead may be affected.
  • Pain in one side of the face at a time.
  • Pain focused in one place. Or the pain may be spread in a wider pattern.
  • The pain rarely occurs during sleep.
  • The episodes of pain become more frequent and intense over time.

When to see a doctor

Consult your health care professional if you experience pain in your face, especially if it is of long duration or comes back after being gone. Also get medical attention if you have chronic pain that doesn't go away with medication for the pain that you buy off the shelf.

Causes

In trigeminal neuralgia, the trigeminal nerve's function is disrupted. The contact between vessels and the trigeminal nerve at the base of the brain, often causing the pain. The blood vessel can be an artery or a vein. This contact puts pressure on the nerve, and not allow it to function as usual.

But while the compression from a blood vessel is a common cause, there are many other possible causes. Multiple sclerosis or a similar condition that damages the myelin sheath protecting certain nerves can cause trigeminal neuralgia. A tumor pressing against the trigeminal nerve can also cause the disease.

Some people may experience trigeminal neuralgia as a result of a stroke, or facial trauma. A nerve injury due to surgery can also cause trigeminal neuralgia.

Triggers

Several triggers can trigger the pain of trigeminal neuralgia, including:

  • Shaving.
  • Touching your face.
  • Eat.
  • Drink.
  • The brushing of their teeth.
  • Talking about.
  • Putting on makeup.
  • A slight breeze blowing on your face.
  • Smiling.
  • Washing your face.

Risk factors

Research has found that some of the factors that put people at increased risk of trigeminal neuralgia, including:

  • Sex. Women are more likely than men to experience the trigeminal neuralgia.
  • Age. The trigeminal neuralgia is more common among people older than 50 years.
  • Certain conditions. For example, hypertension is a risk factor for trigeminal neuralgia. In addition, people with multiple sclerosis are at increased risk of trigeminal neuralgia.

Diagnosis

Your health care professional for the diagnosis of trigeminal neuralgia mainly based on your description of the pain, including:

  • Type. Pain related to trigeminal neuralgia is sudden, it feels like an electric shock and is brief.
  • Location. The parts of the face affected by the pain you can tell your health care professional if the trigeminal nerve is involved.
  • Triggers. To eat, to talk, to touch the light of your face, or even a light breeze can produce pain.

Your health care professional may carry out tests to diagnose trigeminal neuralgia. The tests can also help find the cause of the condition. They may include:

  • A neurological exam. Touch and examine the parts of your face can help you to determine exactly where the pain is occurring. If you appear to have trigeminal neuralgia, the test can help you figure that branches of the trigeminal nerve may be affected. Reflex tests can help determine if your symptoms are caused by a compression of the nerve or of another condition.
  • Magnetic resonance imaging (MRI). You may need an mri scan to look for possible causes of trigeminal neuralgia. An mri may reveal signs of multiple sclerosis or a tumor. Sometimes, a dye is injected into a blood vessel to view the arteries and veins to show the flow of blood.

Your facial pain can be caused by many different conditions, so that an accurate diagnosis is important. Your healthcare provider may also order other tests to rule out other conditions.

Treatment

Trigeminal Neuralgia treatment usually starts with medications, and some people do not need any additional treatment. However, with time, some people with the condition may stop responding to medications, or they may experience unpleasant side effects. For those people, injections, or surgery to offer other options of treatment of trigeminal neuralgia.

If your condition is due to another cause, such as multiple sclerosis, you need to treat the underlying condition.

Drugs

For the treatment of trigeminal neuralgia, the health professionals prescribe medications to lessen or block the pain signals sent to the brain.

  • Anti-epileptic drugs.Health professionals often prescribe carbamazepine (Tegretol, Carbatrol, other) for trigeminal neuralgia. It has been shown to be effective in the treatment of the condition. Other anti-epileptic drugs that may be used include oxcarbazepine (Trileptal, Oxtellar XR), lamotrigine (Lamictal), phenytoin (Dilantin, Phenytek, Dilantin). Other medications that may be used include topiramate (Qudexy XR, Topamax, others), pregabalin (Lyrica) and gabapentin (Neurontin, Gralise, Horizant). If the anti-seizure medication that you are using becomes less effective, your healthcare provider may increase your dosage or switch you to another type. Side effects of anti-seizure medications may include dizziness, confusion, drowsiness, and nausea. Also, carbamazepine can cause a severe reaction in some people, mainly those of Asian origin. Genetic testing may be recommended before starting carbamazepine.
  • Muscle relaxants. Drugs for muscle relaxation, such as baclofen (Gablofen, Fleqsuvy, other) may be used alone or in combination with carbamazepine. Side effects may include confusion, nausea, and drowsiness.
  • Injections of Botox. Small studies have shown that onabotulinumtoxinA (Botox) injections can reduce the pain of trigeminal neuralgia in people who are no longer helped by medications. However, more research needs to be done before this treatment is widely used for this condition.

Anti-epileptic drugs. Health professionals often prescribe carbamazepine (Tegretol, Carbatrol, other) for trigeminal neuralgia. It has been shown to be effective in the treatment of the condition.

Other anti-epileptic drugs that may be used include oxcarbazepine (Trileptal, Oxtellar XR), lamotrigine (Lamictal), phenytoin (Dilantin, Phenytek, Dilantin). Other medications that may be used include topiramate (Qudexy XR, Topamax, others), pregabalin (Lyrica) and gabapentin (Neurontin, Gralise, Horizant).

If the anti-seizure medication that you are using becomes less effective, your healthcare provider may increase your dosage or switch you to another type. Side effects of anti-seizure medications may include dizziness, confusion, drowsiness, and nausea. Also, carbamazepine can cause a severe reaction in some people, mainly those of Asian origin. Genetic testing may be recommended before starting carbamazepine.

Surgery

Surgical options for trigeminal neuralgia include:

  • Microvascular decompression.This procedure involves the displacement or the extraction of blood vessels that touch the trigeminal nerve to stop the nerve malfunction. A court, known as an incision is made behind the ear on the side where you feel the pain. Then, through a small hole in the skull, the surgeon moves any arteries that are in contact with the trigeminal nerve. The surgeon places a soft cushion between the nerve and the artery. If a vein is the compression of the nerve, the surgeon may remove the. Part of the trigeminal nerve can be cut if arteries are not exerting pressure on the nerve. This is known as a neurectomy. Microvascular decompression may stop or reduce the pain for many years. Long-term relief of the pain depends on the location of pain, type of pain and the age of the person. People with a blood vessel is seen that the compression of the nerve can stay pain-free for years after the procedure. Only a small number of people may have back pain of 3 to 5 years after surgery. Microvascular decompression has some risks, including the loss of hearing, facial weakness, facial numbness, stroke, or other complications. Most of the people who have this procedure does not have facial numbness after.
  • The brain stereotactic radiosurgery, also known as the Gamma knife.In this procedure, a surgeon objectives of a concentrated dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve to reduce or stop the pain. The relief of pain occurs gradually and can take up to a month. The brain stereotactic radiosurgery is successful in stopping the pain for most people. But as with all procedures, there is a risk that the pain may come back, often within 3 to 5 years. If the pain returns, the procedure can be repeated, or you may have another procedure. Facial numbness is a common side effect, and may occur months or years after the procedure.

Microvascular decompression. This procedure involves the displacement or the extraction of blood vessels that touch the trigeminal nerve to stop the nerve malfunction. A court, known as an incision is made behind the ear on the side where you feel the pain. Then, through a small hole in the skull, the surgeon moves any arteries that are in contact with the trigeminal nerve. The surgeon places a soft cushion between the nerve and the artery.

If a vein is the compression of the nerve, the surgeon may remove the. Part of the trigeminal nerve can be cut if arteries are not exerting pressure on the nerve. This is known as a neurectomy.

Microvascular decompression may stop or reduce the pain for many years. Long-term relief of the pain depends on the location of pain, type of pain and the age of the person. People with a blood vessel is seen that the compression of the nerve can stay pain-free for years after the procedure. Only a small number of people may have back pain of 3 to 5 years after surgery. Microvascular decompression has some risks, including the loss of hearing, facial weakness, facial numbness, stroke, or other complications. Most of the people who have this procedure does not have facial numbness after.

The brain stereotactic radiosurgery, also known as the Gamma knife. In this procedure, a surgeon objectives of a concentrated dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve to reduce or stop the pain. The relief of pain occurs gradually and can take up to a month.

The brain stereotactic radiosurgery is successful in stopping the pain for most people. But as with all procedures, there is a risk that the pain may come back, often within 3 to 5 years. If the pain returns, the procedure can be repeated, or you may have another procedure. Facial numbness is a common side effect, and may occur months or years after the procedure.

Other procedures may be used to treat trigeminal neuralgia, such as rhizotomy. In a rhizotomy, your surgeon destroys the nerve fibers to reduce the pain. This makes some facial numbness. Types of rhizotomy include:

  • The injection of glycerol.A needle that goes through the face and into an opening in the base of the skull that provides medicine to reduce the pain. The needle is guided to a small sac filled with cerebrospinal fluid that surrounds the area where the trigeminal nerve divides into three branches. Then, a small amount of glycerol, sterile injected. The glycerol damage of the trigeminal nerve and blocks the pain signals. This procedure is often relieves the pain. However, the pain returns in some people. Many people experience facial numbness or a tingling sensation after glycerol injection.
  • Globe of compression.This procedure involves the insertion of a hollow needle through the face. It is guided to a part of the trigeminal nerve that passes through the base of the skull. Then, a thin, flexible tube called a catheter with a balloon on the end is inserted through the needle. The balloon is inflated with enough pressure to damage the trigeminal nerve and block the pain signals. Globe of compression successfully controls pain in most people, at least for a period of time. Most people who undergo this procedure experience at least some temporary facial numbness.
  • Radiofrequency thermal lesions.This procedure selectively destroys the nerve fibers associated with pain. While you are sedated, the surgeon inserts a hollow needle through your face. The surgeon guides the needle to a part of the trigeminal nerve, which passes through an opening in the base of your skull. Once the needle is placed, your surgeon will briefly wake up from the sedation. The surgeon inserts an electrode through the needle and sends a mild electrical current through the electrode tip. You will be asked to say when and where you feel like a tickle. When the surgeon locates the part of the nerve is involved in your pain, you will go back to the sedation. Then, the electrode is heated to damage to the nerve fibers, the creation of an area of the injury is known as a lesion. If the injury does not get rid of your pain, your doctor may create additional injuries. Radiofrequency thermal lesions usually results in some temporary facial numbness after the procedure. The pain may return after 3 to 4 years.

The injection of glycerol. A needle that goes through the face and into an opening in the base of the skull that provides medicine to reduce the pain. The needle is guided to a small sac filled with cerebrospinal fluid that surrounds the area where the trigeminal nerve divides into three branches. Then, a small amount of glycerol, sterile injected. The glycerol damage of the trigeminal nerve and blocks the pain signals.

This procedure is often relieves the pain. However, the pain returns in some people. Many people experience facial numbness or a tingling sensation after glycerol injection.

Globe of compression. This procedure involves the insertion of a hollow needle through the face. It is guided to a part of the trigeminal nerve that passes through the base of the skull. Then, a thin, flexible tube called a catheter with a balloon on the end is inserted through the needle. The balloon is inflated with enough pressure to damage the trigeminal nerve and block the pain signals.

Globe of compression successfully controls pain in most people, at least for a period of time. Most people who undergo this procedure experience at least some temporary facial numbness.

Radiofrequency thermal lesions. This procedure selectively destroys the nerve fibers associated with pain. While you are sedated, the surgeon inserts a hollow needle through your face. The surgeon guides the needle to a part of the trigeminal nerve, which passes through an opening in the base of your skull.

Once the needle is placed, your surgeon will briefly wake up from the sedation. The surgeon inserts an electrode through the needle and sends a mild electrical current through the electrode tip. You will be asked to say when and where you feel like a tickle.

When the surgeon locates the part of the nerve is involved in your pain, you will go back to the sedation. Then, the electrode is heated to damage to the nerve fibers, the creation of an area of the injury is known as a lesion. If the injury does not get rid of your pain, your doctor may create additional injuries.

Radiofrequency thermal lesions usually results in some temporary facial numbness after the procedure. The pain may return after 3 to 4 years.

Alternative medicine

Alternative treatments for trigeminal neuralgia has not been studied as well as the medications or surgical procedures. There is often little evidence to support its use.

However, some people have found improvement with treatments such as acupuncture, biofeedback, chiropractic, and the vitamin or nutritional therapy. Be sure to consult with your doctor before you try an alternative treatment because it can interact with the other treatments.

Coping and support

Living with trigeminal neuralgia can be difficult. The disorder may affect their interaction with friends and family, their productivity in the workplace, and the overall quality of your life.

You can find encouragement and understanding in a support group. Group members often know about the latest treatments and they tend to share their own experiences. If you are interested, your doctor may be able to recommend a group in your area.

Preparing for your appointment

Make an appointment with your health care professional if you have symptoms of trigeminal neuralgia. After your initial visit, you can see a doctor trained in brain and nervous system conditions, known as a neurologist.

What you can do to prepare

  • Write down any symptoms you've had, and for how long.
  • Note the triggers that lead to the facial pain.
  • Make a list of your key medical information, including any other condition that is being treated. Also included are the names of the medications, vitamins, or supplements you are taking.
  • Have a family member or friend along, if possible. Someone who comes with you may remember something that you missed or forgot.
  • Write down your questions in advance. This can help you make the most of your time with your health care professional.

So that it is possible to trigeminal neuralgia, some basic questions to ask include:

  • What is the most likely the cause of my pain?
  • I need the diagnostic tests?
  • What treatment approach do you recommend?
  • If you are recommending medications, what are the possible side effects?
  • I'm going to need treatment for the rest of my life?
  • How much do you expect my symptoms improve with treatment?
  • Surgery is an option?

In addition to the questions you have prepared, do not hesitate to ask any of the others that arise during your visit. Also ask questions if you don't understand something.

What to expect from your doctor

It is likely to be a series of questions. Be prepared to respond to them can give more time to go over points you want to discuss more. Your health care professional may ask:

  • What are their symptoms and where they are located?
  • When was the first to develop these symptoms?
  • The symptoms worsened over time?
  • How often do you experience periods of pain facial? Have you noticed if something seems to trigger your facial pain?
  • How much facial pain usually last?
  • How much are these symptoms that affect your quality of life?
  • Have you ever had a dental surgery or surgery in or near your face, as the surgery of the breasts?
  • Have you had a facial trauma, such as an injury or accident which affected the face?
  • Have you tried any treatment for facial pain until now? Nothing has helped?
  • What side effects have you experienced treatment?
Symptoms and treatment of Trigeminal neuralgia