Trigeminal neuralgia is a common problem. This condition can provoke pain on the right side of the face. Commonly, a patient might experience electric jolts to the eye and lower jaw, with a constant pressure on the right side of the head. These attacks are common at night when the patient is relaxed, and rarely occur when the patient is working or moving about. This presents a difficulty, as the patients are often afraid to completely let themselves go and relax for fear of attack. That is why they should all seek more info about trigeminal neuralgia, tips and advices on how to live with it.
What is trigeminal neuralgia?
It is common for trigeminal neuralgia patients to experience a jab of lightning-like pain shoot through their face when they brush teeth or put on makeup. Off course, these attacks might sound excruciating. If you have trigeminal neuralgia, attacks of such pain are frequent and can often seem unbearable. You may initially experience short, mild attacks, but trigeminal neuralgia can progress. If this happens, it starts causing longer and more frequent bouts of searing pain. These painful attacks can be spontaneous, but they may also occur after a mild stimulation of your face, including brushing your teeth, shaving, or putting on makeup. The pain of trigeminal neuralgia may happen in a small area of the face, or it may spread rapidly over a wider area.
Because of the variety of treatment options available, having trigeminal neuralgia does not necessarily mean you are doomed to a life of pain. Doctors usually can manage trigeminal neuralgia effectively with medications or surgery.
Trigeminal neuralgia, or tic douloureux, is a condition that affects the trigeminal nerve. That is the fifth cranial nerve, and one of the largest nerves in the head. The trigeminal nerve is responsible for sending impulses of touch, pain, pressure, and temperature to the brain. Impulses came from the face, jaw, gums, forehead, and around the eyes. For trigeminal neuralgia, a sudden and severe electric shock-like or stabbing pain is common symptom. This pain is common on one side of the jaw or cheek. The disorder is more common in women than in men and rarely affects anyone below the age of fifty. The pain attacks generally last several seconds and may repeat one after the other. The attacks may come and go throughout the day and last for days, weeks, or months at a time. The pain could also disappear for months or years.
What causes trigeminal neuralgia?
Doctors are not exactly sure what causes trigeminal neuralgia, but believe it could be the degeneration or irritation of the trigeminal nerve. Some believe the pain occurs when an abnormally formed artery puts pressure on the nerve.
We could divide the trigeminal nerve into three branches. This nerve is responsible for chewing, producing saliva and tears, and sending facial sensations to the brain. Doctors can tell which branch affects trigeminal neuralgia by the location of the pain. Neuralgia of the first branch causes pain around the eyes and over the forehead, while the second branch causes pain in the upper lip, nose, and cheek. Neuralgia of the third branch causes pain on the side of the tongue and lower lip as well.
What are the symptoms for trigeminal neuralgia?
Trigeminal neuralgia causes pain that occurs suddenly and spontaneously. People describe this excruciating pain as feeling like an electric shock, where the pain is usually so severe that it prevents the person from acting. The pain usually begins from the same area of the face each time. It happens often in the cheek next to the nose or in the jaw area as well. Trigeminal neuralgia causes more severe pain at the ends of the affected nerve, especially over the nostrils, lip, chin, or teeth. Often, the pain triggers by touching a certain spot on the face, such as when washing or shaving, or even by activities such as talking, eating, or drinking. At the beginning, the episodes of pain are brief and it could be weeks before another attack. With time, however, the episodes occur more frequently and become more painful. In some people, the pain occurs as much as a hundred times a day, which can cause people to limit their activities because they are so fearful of another attack.
What is the treatment of trigeminal neuralgia?
Typical pain medications may not be effective with trigeminal neuralgia in some cases. The reason is that the pain is brief and does not occur at regular, predictable intervals. Anti-seizure drugs, such as Carbamazepine and Phenytoin, are able to suppress pain. This is possible because they slow down the nerve signals at certain nerve terminals. Because these types of drugs can cause a number of different side effects, your doctor will monitor dosage carefully. The doctor might also need to try different types of drugs to control the discomfort you experience due to trigeminal neuralgia. The problem is, symptoms usually return when you stop using these medications. In cases where drug treatment is not effective, the doctor could choose to have the nerve deadened with gamma rays, radio frequency waves, or glycerol injections.
The doctor could also cut or permanently destroy the nerve, as one of the treatment options. This type of treatment, however, can leave lasting facial discomfort and doctors only recommend it in severe cases. If trigeminal neuralgia is there because an artery or tumor compressing the nerve, you might need surgery to free the nerve from the source of pressure and permanently relieve the pain. Your doctor should make sure you are aware of all the risks and possible complications associated with any surgical treatment available.
Tips and advices for trigeminal neuralgia
Although there is no way to prevent trigeminal neuralgia, you can take steps to avoid attacks. For one, you have to know what triggers the attacks you are feeling; avoid very cold or very hot food and drinks, do not chew your food on the painful side, and do not eat extremely hard or crunchy foods. Try to avoid splashing your face with very hot or cold water when washing, and rinse your mouth with water after every meal instead of using a toothbrush (as you normally should). Although medications are the usual initial treatment for trigeminal neuralgia, those are not always effective in lessening or blocking the pain signals sent to your brain. If you stop responding to a particular medication or experience too many side effects, your doctor might switch you to another treatment option for trigeminal neuralgia.
- Medications used for trigeminal neuralgia are Carbamazepine, Baclofen, and Oxcarbazepine as the most common choice. However, some people with trigeminal neuralgia eventually stop responding to medications, or they experience unpleasant side effects. For those people surgery, or a combination of surgery and medications, may be an even better treatment option.
- Surgery has the goal to either damage or destroy the part of the trigeminal nerve that is the source of your pain. Because the success of these procedures depends on damaging the nerve, facial numbness of varying degree is a common side effect. These procedures involve alcohol injections under the skin of your face. It should inject where the branches of the trigeminal nerve leave the bones of your face. It may offer temporary pain relief by numbing the areas for weeks or months. Because the pain relief is not permanent, you may need repeated injections or a different procedure.
- Glycerol injection and balloon compression are also commonly used procedures in treatment of trigeminal neuralgia.
- Electric current is used in a procedure called percutaneous stereotactic radiofrequency thermal rhizotomy. This procedure selectively destroys nerve fibers associated with pain. Your doctor threads a needle through your face and into an opening in your skull; so once in place, an electrode threads through the needle until it rests against the nerve root. An electric current passes through the tip of the electrode until it heats to the desired temperature. The heated tip damages the nerve fibers and creates an area of injury.
- Microvascular decompression does not damage or destroy part of the trigeminal nerve. Instead, MVD involves relocating or removing blood vessels that are in contact with the trigeminal root, separating the nerve root and blood vessels with a small pad. During MVD, the doctor makes an incision behind one ear. Then, through a small hole in your skull, part of your brain is lifted to expose the trigeminal nerve. If your doctor finds an artery in contact with the nerve root, he or she directs it away from the nerve and places a pad between the nerve and this artery. Doctors usually remove a vein found to be compressing the trigeminal nerve. MVD can successfully eliminate or reduce pain most of the time. However, as with all other surgical procedures for trigeminal neuralgia, pain can recur in some people. There are also small chances of decreased hearing, facial weakness, facial numbness, double vision, and even a stroke or death. The risk of facial numbness is less with MVD than with procedures that involve damaging the trigeminal nerve.
- Severing the nerve is a procedure called partial sensory rhizotomy. This procedure involves cutting part of the trigeminal nerve at the base of your brain. Through an incision behind your ear, your doctor makes a quarter-sized hole in your skull to access the problematic nerve. This procedure is usually helpful, but always causes facial numbness. In addition, it is possible for the pain to recur. If your doctor does not find an artery or vein in contact with the trigeminal nerve, he or she will do PSR.
- Radiation with gamma-knife radiosurgery involves delivering a focused, high dose of radiation to the root of the trigeminal nerve. The radiation damages the trigeminal nerve and reduces or eliminates the pain, but relief is not immediate. It can take several weeks before you start feeling better. Sometimes the pain may recur after this procedure. The procedure is painless and typically done without anesthesia. Because this procedure is relatively new, we still do not know the long-term risks of this type of radiation.