The pain of trigeminal neuralgia is sudden, feels like an electric shock and lasts seconds or a few minutes. It can be triggered by chewing, brushing teeth, talking and even a cool breeze touching the face.
Doctors can control the pain with medication or surgery. Some surgical procedures are outpatient, but others require an overnight stay in hospital under general anesthesia.
Causes
TN can be caused by compression of the trigeminal nerve by blood vessels that press against it, destroying its protective covering (myelin sheath). Sometimes the pressure is increased by the growth of a tumor or by the tangle of arteries that surrounds the nerve. TN can also be the result of a stroke or an injury to the trigeminal nerve. It affects twice as many women as men and is more common in people over 50. There are some diseases, such as multiple sclerosis, that increase the risk of developing TN. It is also linked with high blood pressure, smoking and the use of antidepressants.
The most effective treatment for TN is surgery to remove the blood vessel compressing the trigeminal nerve. This is most effective in preventing pain long-term, but it is the most invasive of surgical options and can carry risks, including a spinal fluid leak, damage to hearing or, rarely, a stroke.
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Your specialist will discuss the surgical procedures with you to see if any are right for you. They will take into account your general health, age and the severity of your pain.
Microvascular decompression (MVD, or the Jannetta procedure) is the most commonly used surgical procedure for TN. It involves opening the skull and removing any blood vessels that are pressing on the trigeminal nerve. By moving these blood vessels and inserting Teflon felt padding between them, the surgeon can relieve pain in most patients.
A less invasive surgery option is radiosurgery, which uses focused radiation to block pain signals from the trigeminal nerve. This can be a good choice for people who cannot tolerate the side effects of other surgeries or for whom medication does not provide sufficient relief from TN.
Other treatments for TN include physical therapy, acupuncture and nutritional supplements. While these have not been as well studied as medications or surgical procedures, some people find that they help. You may want to try a few of these before you decide what is best for you. If you are unsure where to start, visit the Trigeminal Neuralgia Association Australia or healthdirect to talk to a registered nurse about your symptoms.
Symptoms
Trigeminal neuralgia causes intense pain in the face, jaw or lips. The pain episodes are recurrent, sharp, shooting or stabbing, and typically last a fraction of a second to 2 minutes. Trigeminal Neuralgia is a very debilitating condition that affects a person’s quality of life and may cause social isolation due to fear of talking or eating. It can also trigger depression and anxiety.
There are 12 pairs of nerves in your head, called cranial nerves, that let you feel sensations like touch and pain. One of the pair on each side is your trigeminal nerve, which runs down both sides of your head. It’s responsible for transmitting touch and pain signals to the brain from your eyes, eyelids, forehead, nostrils, cheek, upper lip, gums, and the muscles used for chewing.
Sometimes a blood vessel or another structure, like a tumor or multiple sclerosis, can press on the trigeminal nerve. Other times, the nerve can develop a condition called trigeminal neuralgia without any obvious cause. In some cases, it can be caused by a condition called demyelination, where the protective sheath around the nerve becomes damaged.
Your doctor diagnoses TN by listening to your description of the pain and conducting a physical examination. An MRI scan or CT scan can be used to rule out other conditions that can cause similar symptoms, such as a brain tumor or multiple sclerosis.
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The most common treatment for TN is medications that reduce pain signals from the trigeminal nerve. These medications are primarily anti-seizure medicines, including carbamazepine (Tegretol), oxcarbazepine (Trileptal), lamotrigine (Lamictal), and phenytoin (Dilantin). The pain reliever gabapentin (Neurontin) is also often prescribed for TN.
In addition to medical treatments, a counselor or chronic pain support group can help you cope with the emotional and psychological impacts of TN. A therapist can teach you stress reduction techniques and suggest ways to modify your lifestyle to avoid triggers. For example, you can learn to eat a healthier diet that minimizes junk food and processed foods. You can also find a way to eat that doesn’t require too much chewing, such as blending up your meals or using a soft-chew utensil.
Diagnosis
Trigeminal neuralgia (TN) is a painful condition affecting one of the largest nerves in your head. TN causes sudden, severe attacks of facial pain that last from seconds to 2 minutes and can occur on one or both sides of the face. The pain can be burning, throbbing, or stabbing and feels like an electric shock. Symptoms can be severe and can affect the quality of your life. People with TN are at increased risk for depression and sleep problems.
Your doctor will diagnose TN by listening to your description of the pain and doing a physical exam. He or she may also order an MRI of the brain to determine what is causing your pain, such as a blood vessel pressing on the trigeminal nerve or multiple sclerosis. Other tests may include a CAT scan or high-resolution MRI of the brain to find where the trigeminal nerve is affected.
Healthcare providers prescribe medicines to lessen or block the pain signals that the trigeminal nerve sends to your brain. The medicine often starts with carbamazepine (Tegretol, Carbatrol), oxcarbazepine (Trileptal, Oxtellar XR), lamotrigine (Lamictal), or phenytoin (Dilantin, Phenytek, Cerebyx). These medicines may have side effects, so you’ll need regular blood tests to check your white blood cells, platelets, and sodium levels.
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Surgery can help some people with TN, especially if medications don’t work or cause side effects. The most common surgical procedure for TN is called microvascular decompression, or MVD. During MVD, your surgeon moves or removes any arteries that touch the trigeminal nerve, which stops them from pressing on the nerve and triggering an attack. The most recent research suggests that this operation has the best chance of preventing recurrence and providing long-term pain relief.
Another option is radiofrequency lesioning, which uses a precise beam of radiation to cut the trigeminal nerve in the area where you have pain. This is a good choice for patients who aren’t candidates for open surgery, such as those with other illnesses that make an open procedure too dangerous. MVD and radiofrequency lesioning have similar results, but MVD has the advantage of being an outpatient procedure.
Treatment
Medications are usually the first treatment for trigeminal neuralgia. Your healthcare provider may prescribe anticonvulsant drugs, which are used to treat seizures, to help control TN pain. The most common is carbamazepine (Tegretol(r)). This drug works in about 80% to 90% of people with TN and may reduce your symptoms for several years. Other medications in this class include gabapentin (Neurontin(r)), lamotrigine (Lamictal(r)) and oxcarbazepine (Trileptal(r)). The muscle relaxant baclofen (Lioresal(r)) is also sometimes prescribed for TN.
You can find more information about these medicines and their side effects by visiting the websites for the medicines you’re taking or talking to your pharmacist. If medication doesn’t manage your symptoms, or if you experience severe side effects, you can ask your healthcare provider to refer you to a specialist in headaches, brain and nervous system conditions or surgery.
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Some surgical procedures are successful in reducing or eliminating TN pain for several years. They are generally less invasive than other types of surgery and can be repeated if necessary. Gamma knife radiosurgery is a non-invasive procedure in which a focused beam of radiation damages the trigeminal nerve and blunts pain signals. Other surgical options include a glycerol injection that injects liquid into the spinal fluid surrounding the trigeminal nerve at the base of your skull to damage insulation and a rhizotomy, in which doctors cut part of the trigeminal nerve to prevent it from transmitting pain.
Alternative treatments have not been scientifically tested for TN, but some people report improvement with acupuncture, biofeedback therapy and chiropractic or vitamin therapies. If you are interested in trying an alternative treatment, check with your healthcare provider to make sure it won’t interfere with your other treatments. You might also benefit from joining a support group for people with TN, which can provide encouragement and information about the latest treatments. Some people with TN find relief from the stress and anxiety caused by their condition by participating in a therapy or activity they enjoy. It can improve their quality of life and help them cope with the chronic nature of TN.
