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Trigeminal Neuralgia

Trigeminal Neuralgia is a chronic and painful condition that affects the trigeminal nerve. It is considered to be one of the most painful nerve disorders. The pain involves the lower face and jaw but sometimes can affect the area around the nose and eyes. The pain has been equated to an intense stabbing, electric shock like pain.

Causes

The pain is caused by irritation of the trigeminal nerve which sends nerve signals to the forehead, cheek and lower jaw.

Symptoms

The symptoms of trigeminal neuralgia may range from mild to extreme and may fluctuate in intensity. Even the slightest touch to the face can initiate symptoms. These symptoms can be one or the combination of the following:

  • Occasional bouts of mild pain
  • Episodes of severe pain that are triggered from simple things like putting on make-up, touching the face or brushing the teeth.
  • Episodes of severe stabbing, shooting or electric shock type pain.
  • Pain affecting one side of the face at a time.
  • Pain focused in one area or spreading to other surrounding areas.
  • Pain that becomes more frequent and intense over a period of time.

Diagnosis

The diagnosis of trigeminal neuralgia is based mainly on a patients symptoms and description of pain. The areas of the face that are affected by the pain will help your doctor determine of the trigeminal nerve is involved. The symptoms and triggers of the pain will also be discussed to track what causes the symptoms the most frequently. It is important for your doctor to perform a full neurological exam to determine if something else may be causing the pain. Tests such as an MRI may also be ordered to rule out other conditions.

Treatment

reatment of trigeminal neuralgia usually begins with conservative treatment with anticonvulsant medications which usually helps most people with the pain control. Along with muscle relaxers, trigeminal neuralgia may be effectively treated and a person may not require surgery. There are some drawbacks to medication other than the side effects. Sometimes a high dose of medication is necessary to relive the symptoms. Anticonvulsant drugs may lose their effectiveness or a patient need a second medication to alleviate the pain which can cause adverse drug interactions. These medications can also be toxic to individuals with a history of bone marrow conditions or kidney or liver toxicity.

If treatment with medication proves to be ineffective your physician may suggest surgery to relieve the pressure on the trigeminal nerve. Surgeries such as microvascular decompression which involves microsurgical exposure of the trigeminal nerve root, identification of a blood vessels that maybe compressing the nerve and gently moving the vessel to where it is not compressing the nerve. If a vein is compressing the nerve your surgeon may remove it if necessary. Microvascular decompression can work in most cases to relieve the pain and symptoms of trigeminal neuralgia however pain can reoccur in some people. If there is no compression from blood vessels, your surgeon may cut part of the nerve.

Gamma Knife may also be used to successfully treat trigeminal neuralgia. Gamma Knife radiosurgery is a non-surgical treatment in which your surgeon will direct a focused dose of radiation to the root of the trigeminal nerve. This will damage the area of the trigeminal nerve responsible for causing the pain. The results of Gamma Knife occur gradually and may take a few weeks to fully alleviate the pain. Gamma Knife is an effective non-surgical way to treat pain and more and more surgeons are using it to treat trigeminal neuralgia. SCCNS is proud to be one of the few centers that offers Gamma Knife at the Regional Gamma Knife Center in Upland, CA.

Other options for the treatment of trigeminal neuralgia are also available. Your expert at SCCNS can discuss all options with you and can guide you in the best treatment option.

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