Everything You Wanted To Know About Trigeminal Neuralgia

Trigeminal Neuralgia is a chronic, pain associated disorder that affects the region of the head and neck innervated by the Trigeminal nerve. This disorder has been found to affect women more commonly than men and is also more likely to be seen in people over the age of 50. It is also called as tic douloureux.

What Causes Trigeminal Neuralgia?

Unfortunately, the exact reason why a person develops Trigeminal neuralgia is still unknown. There are many theories that are suspected, however in a large majority of the cases the exact cause may remain a mystery. Scientists have postulated that an increased pressure on the nerve by aneurisms, nearby blood vessels or even a tumor can lead to Trigeminal Neuralgia. An inflammatory process around the nerve has also been implicated in the etiology of the disease. Such a reaction can be seen in certain systemic disorders like sarcoidosis, multiple sclerosis and Lyme disease.

All of these theories and associations are, however, incomplete and a lot more research is needed into determining the exact chain of events that lead to the causation of Trigeminal Neuralgia.

So what are some of the symptoms that you should look out for, diagnostic tests that can be done, treatment options available and long term prognosis?

Symptoms Of Trigeminal Neuralgia

Pain

Trigeminal Neuralgia is a major cranial nerve of the body. It carries both motor and sensory sensations from various parts of the head, face and neck to the brain. The chief complaint of people suffering from Trigeminal Neuralgia is pain. This pain can be felt in various parts of the face along the path of distribution of the nerve. The severity of the pain is also variable, however it has been noted that it increases over a period of time.

These bouts of pain or attacks are on the face, jaws, gums, forehead, around the eyes and the ears. Most patients describe the pain as a sharp electric current, stabbing and piercing in nature that can last for several seconds to a few minutes before subsiding. Frequency of these attacks too increases as the disease progresses.

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Some of the more common triggers are shaving, applying makeup, lightly touching the face, exposure to a head wind, brushing the teeth and even swallowing. Most of these triggers are not something that you can easily guard against and so bouts of pain are inevitable. Patients often feel like they are living in fear of the next sudden attack of pain and are unable to enjoy daily activities leading to severe depression and a deterioration of the quality of life.

Diagnosis And Treatment options For Trigeminal Neuralgia

Diagnosis

The diagnosis of Trigeminal Neuralgia is a clinical decision and does not require any other investigations. However, certain criteria have been defined to help in coming to this decision. This is just an aid for the clinician and includes certain things like the presence of ocular reflexes, absence of muscular weakness and the presence of pain which is piercing in nature and precipitated through trigger zones.

Treatment Options

The treatment for chronic pain disorders is difficult in general, and even more so when the cause is unknown. There are quite a few options available to the patients today which can help them manage Trigeminal Neuralgia and live a normal life.

The first choice drug is the anti-convulsant Carbamezapine. This drug is usually used in the treatment of epilepsy patients and has been successful in the treatment of idiopathic Trigeminal Neuralgia. The second line of drugs includes Gabapentin and Phenytoin. Often these drugs will be used in conjunction with Carbamezapine.

The treatment with drugs is more effective if Trigeminal Neuralgia has been diagnosed at an early stage and is contained to one branch of the trigeminal nerve. Over a period of time the effectiveness of these drugs can reduce and may require a surgical intervention.

Earlier surgical options for Trigeminal Neuralgia used to be crude, betraying a lack of understanding of the disease. The use of alcohol injections along the path of the nerve at various parts used to be popular, however this is an extremely hit and miss option. The idea was to destroy the pain fibers, however the selectivity for those fibers by alcohol was extremely low.

Patients have reported a high level of relief after these surgical procedures. It should be remembered that these surgeries carry the risk of permanent anesthesia over the face as well something called as anesthetic dolorosa. These can be disabling to the patient and can actually leave a patient worse off than before. Out of the three surgical options mentioned, recent peer reviews have found the microvascular decompression technique to be the most successful at relieving pain as well as having the least chance of serious complications.

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One important thing to remember here is that all surgical procedures were found to be more effective in Trigeminal Neuralgia cases that were detected early and were limited in their extent to one branch of the nerve.

Conclusion

While Trigeminal Neuralgia is a chronic pain disorder that has the potential to greatly affect your lifestyle and choices, it is being managed without too much trouble by the vast majority of patients suffering from it. As in any other condition, the key lies with early detection and beginning proper treatment as soon as possible for the best chance of a favorable outcome.