Overview
On one side of the face, trigeminal neuralgia is a disorder causing great discomfort similar to an electric shock. It influences the trigeminal nerve, which runs from the face to the brain, carrying messages. A bolt of agony could be triggered even by a light touch, like brushing your teeth or applying cosmetics. Trigeminal neuralgia can be protracted. It is recognized as a chronic pain disorder.
Trigeminal neuralgia patients initially may have brief, moderate pain attacks. The disorder can, however, worsen and result in more frequent, longer pain episodes. Women and those aged more than fifty are more likely to have it.
Trigeminal neuralgia does not mean living in terrible pain and suffering. Usually, treatment allows a person to control it.
Signs and Symptoms
Trigeminal neuralgia can present one or more of these symptoms:
- Episodes of sharp shooting or terrible pain are very similar to an electric shock.
- Rapid pain or discomfort brought on by brushing your teeth, chewing, talking, or face contact.
- Pain episodes range from a few seconds to many minutes.
- Pain brought on by facial spasms.
- Days, weeks, months, or longer of pain. Some individuals have periods when they go painless.
- Pain in places that the trigeminal nerve supplies. These include the cheek, jaw, teeth, lips, or gums. Less commonly impacted could be the eye and forehead.
- One side of the face at a time, then pain on the other.
- Concentrated pain in one area. Alternatively, the discomfort could follow a more general pattern.
- Pain that is hardly experienced during sleep.
- Pain episodes that grow more frequent and severe with time.
Causes
The function of the trigeminal nerve is interfered with in trigeminal neuralgia. The pain is frequently brought on by contact between a blood vessel and the trigeminal nerve at the level of the brain. The blood vessel could be a vein or an artery. The nerve loses its normal functions when it is touched.
Although blood vessel compression is a frequent cause, there are numerous additional possible reasons. Trigeminal neuralgia can be brought on by multiple sclerosis or a comparable disorder that weakens the myelin sheath that surrounds certain nerves. The disorder may also be brought on by a tumor pressing against the trigeminal nerve.
Trigeminal neuralgia can strike certain individuals from a stroke or facial trauma. Trigeminal neuralgia can also result from surgical damage to the nerve.
Risk factors
Studies have shown that various elements increase a person’s chances of developing trigeminal neuralgia, including:
- Age. Those 50 years of age and above have an increased trigeminal neuralgia.
- Specific diseases. An example of a risk factor for trigeminal neuralgia is high blood pressure. People with multiple sclerosis also run a greater risk of trigeminal neuralgia.
- Sex. Trigeminal neuralgia is more frequently experienced by females than by males.
Diagnosis
Trigeminal neuralgia is mostly diagnosed by a healthcare provider based on how you described the pain, which includes:
- Site. The healthcare provider can determine whether the trigeminal nerve is involved by examining the areas of your face experiencing pain.
- Triggers. Pain might be brought on by eating, communicating, mild contact with your face, or even cool air.
- Type. Trigeminal neuralgia causes short, abrupt pain similar to an electric shock.
The healthcare provider could run tests to identify trigeminal neuralgia. Furthermore, tests are useful for determining the etiology of the disorder. They could incorporate:
- Examination of Neurological development. Examining and touching different areas of your face will help you identify exactly where the discomfort is coming from. The examination may assist in identifying which trigeminal nerve branches may be impacted if you seem to have trigeminal neuralgia. Reflex tests can assist in identifying another ailment or a compressed nerve as the source of your symptoms.
- MRI, Magnetic Resonance Imaging. Searching for suspected reasons for trigeminal neuralgia could call for an MRI. An MRI could expose evidence of a tumor or multiple sclerosis. Sometimes an indicator is inserted into a blood vessel to observe the veins and arteries to exhibit blood flow.
Since many different diseases could be causing your facial pain, a correct diagnosis is crucial. To rule out different illnesses, the healthcare provider may suggest additional testing.
Treatment
Usually beginning with medication, trigeminal neuralgia treatment is not necessary for everyone. Some persons with the disorder, however, may cease responding to drugs or develop undesirable side effects with time. For certain individuals, surgery or injections offer other trigeminal neuralgia remedies.
You require treatment for the underlying problem if it is caused by any other reason, such as multiple sclerosis.
Medications
Healthcare providers treat trigeminal neuralgia with medications that block or decrease the pain signals reaching your brain.
- Muscle relaxants. Carbamazepine may be taken alone or in combination with muscle-relaxing medications such as baclofen. Confusion, nausea, and drowsiness are among the side effects.
- Anti-seizure medications. For trigeminal neuralgia, healthcare providers routinely write prescriptions for carbamazepine. It has proven to be really successful in curing the disease.
Among the other anti-seizure medications available are lamotrigine, oxcarbazepine, and phenytoin. Other medications perhaps used are pregabalin, topiramate, and gabapentin.
The healthcare provider may change the sort of anti-seizure medication you’re taking or increase the dosage if it starts to lose its effectiveness. Anti-seizure medications might cause side effects, including nausea, dizziness, disorientation, and drowsiness. Furthermore, carbamazepine can cause a major reaction in some people, mostly those of Asian background. Before you start carbamazepine, you might be advised to undergo genetic testing. - Injectable Botox. In those who are not assisted by medication, small studies have indicated that onabotulinumtoxinA (Botox) injections may ease trigeminal neuralgia pain. However, more study is still needed before this treatment is generally recommended for this illness.
Surgery
Trigeminal neuralgia surgical treatments consist of:
- Gamma Knife, sometimes called brain stereotactic radiosurgery. Under this operation, a surgeon targets the root of the trigeminal nerve with a concentrated radiation dose. The radiation destroys the trigeminal nerve to either lessen or cease pain. Pain alleviation could take up to a month and comes gradually.
Most people find success with brain stereotactic radiosurgery in relieving pain. Like other surgeries, there is a chance that pain could return, often within 3 to 5 years. The surgery may be repeated, or you may undergo another surgery if the pain returns. A typical side effect, facial numbness, can strike months or years following the surgery. - Microvascular decompression. To stop the trigeminal nerve from malfunctioning, blood vessels that come into contact with it are either moved or removed in this operation. Behind the ear on the side where you experience the pain, a cut called an incision is made. Your surgeon then passes any arteries that come into contact with the trigeminal nerve via a tiny hole in your head. The surgeon additionally softens the nerve against the arteries.
Your surgeon may remove a vein if it is squeezing the nerve. If no pressure from arteries is on the trigeminal nerve, a portion of the nerve may be removed. This procedure is called a neurectomy.
For several years, microvascular decompression has either stopped or lessened discomfort. The location of the pain, the kind of pain, and the age of the individual determine long-term pain management. Those with a blood artery revealed to be compressing the nerve can go years pain-free following the operation. Few patients can experience pain returning in 3 to 5 years following surgery. Among the dangers of microvascular decompression are facial numbness, reduced hearing, facial weakness, stroke, or other problems. Most patients undergoing this surgery experience no facial numbness following their treatment.
Support and Coping
Trigeminal neuralgia can be challenging. The condition could influence your general quality of life, work performance, and contacts with friends and relatives.
A support group can provide you with understanding and motivation. Usually, group members tend to discuss their own experiences when they know about the newest treatments. Your doctor might be able to suggest a local group if you’re willing to participate.