Trigeminal Neuralgia

Trigeminal Neuralgia

Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. If you have trigeminal neuralgia, even mild stimulation of your face — such as from brushing your teeth or putting on makeup — may trigger a jolt of excruciating pain.

You may initially experience short, mild attacks. But trigeminal neuralgia can progress and cause longer, more-frequent bouts of searing pain. Trigeminal neuralgia affects women more often than men, and it’s more likely to occur in people who are older than 50.
Because of the variety of treatment options available, having trigeminal neuralgia doesn’t necessarily mean you’re doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia with medications, injections or surgery.

 

  • Causes

    In trigeminal neuralgia, also called tic douloureux, the trigeminal nerve’s function is disrupted. Usually, the problem is contact between a normal blood vessel — in this case, an artery or a vein — and the trigeminal nerve at the base of your brain. This contact puts pressure on the nerve and causes it to malfunction.
    Trigeminal neuralgia can occur as a result of aging, or it can be related to multiple sclerosis or a similar disorder that damages the myelin sheath protecting certain nerves. Trigeminal neuralgia can also be caused by a tumor compressing the trigeminal nerve.
    Some people may experience trigeminal neuralgia due to a brain lesion or other abnormalities. In other cases, surgical injuries, stroke or facial trauma may be responsible for trigeminal neuralgia.

  • Symptoms

    • Branches of the trigeminal nerve
    • Open pop-up dialog box
    • 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
    • Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking or brushing teeth
    • Bouts of pain lasting from a few seconds to several minutes
    • Episodes of several attacks lasting days, weeks, months or longer — some people have periods when they experience no pain
    • Constant aching, burning feeling that may occur before it evolves into the spasm-like pain of trigeminal neuralgia
    • Pain in areas supplied by the trigeminal nerve, including the cheek, jaw, teeth, gums, lips, or less often the eye and forehead
    • Pain affecting one side of the face at a time, though may rarely affect both sides of the face
    • Pain focused in one spot or spread in a wider pattern
      Attacks that become more frequent and intense over time

    When to see a doctor

    If you experience facial pain, particularly prolonged or recurring pain or pain unrelieved by over-the-counter pain relievers, see your doctor.

  • Diagnosis

    Your doctor will diagnose trigeminal neuralgia mainly based on your description of the pain, including:
    Type. Pain related to trigeminal neuralgia is sudden, shock-like and brief.
    Location. The parts of your face that are affected by pain will tell your doctor if the trigeminal nerve is involved.
    Triggers. Trigeminal neuralgia-related pain usually is brought on by light stimulation of your cheeks, such as from eating, talking or even encountering a cool breeze.

    Your doctor may conduct many tests to diagnose trigeminal neuralgia and determine underlying causes for your condition, including:
    A neurological examination. Touching and examining parts of your face can help your doctor determine exactly where the pain is occurring and — if you appear to have trigeminal neuralgia — which branches of the trigeminal nerve may be affected. Reflex tests also can help your doctor determine if your symptoms are caused by a compressed nerve or another condition.
    Magnetic resonance imaging (MRI). Your doctor may order an MRI scan of your head to determine if multiple sclerosis or a tumor is causing trigeminal neuralgia. In some cases, your doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiogram).
    Your facial pain may be caused by many different conditions, so an accurate diagnosis is important. Your doctor may order additional tests to rule out other conditions.

  • Treatments at Alleviate

    Trigeminal neuralgia treatment usually starts with medications, and some people don’t need any additional treatment. However, over time, some people with the condition may stop responding to medications, or they may experience unpleasant side effects. For those people, injections or surgery provide other trigeminal neuralgia treatment options.
    If your condition is due to another cause, such as multiple sclerosis, your doctor will treat the underlying condition.

  • Medications

    To treat trigeminal neuralgia, your doctor usually will prescribe medications to lessen or block the pain signals sent to your brain.

    • Anticonvulsants.
    • Antispasmodic agents.
    • Botox injections.

    Cases not responding to medical management and lifestyle modification ,are advised to go for:-

    Radiofrequency thermal lesioning. This procedure selectively destroys nerve fibers associated with pain. While you’re sedated, your surgeon inserts a hollow needle through your face and guides it to a part of the trigeminal nerve that goes through an opening at the base of your skull.

    Once the needle is positioned, your surgeon will briefly wake you from sedation. Your surgeon inserts an electrode through the needle and sends a mild electrical current through the tip of the electrode. You’ll be asked to indicate when and where you feel tingling.

    When your neurosurgeon locates the part of the nerve involved in your pain, you’re returned to sedation. Then the electrode is heated until it damages the nerve fibers, creating an area of injury (lesion). If your pain isn’t eliminated, your doctor may create additional lesions.
    Radiofrequency thermal lesioning usually results in some temporary facial numbness after the procedure. Pain may return after three to four years.

    A few resistant cases may need to consider surgery.
    Microvascular decompression
    Brain stereotactic radiosurgery (Gamma knife)

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