Trigeminal Neuralgia

Trigeminal nerve is a group of nerves that is responsible for chewing and production of saliva. It is present on either side of the ear and trigeminal nerve is also known as fifth cranial nerve. It runs from the brain and passes through your face near the ear. The main nerve separates into three nerve endings and hence called as Tri (three) geminal nerve. Since the nerve goes to your scalp through forehead, cheeks and jaw sharp pain is felt on these areas.

Trigeminal neuralgia can cause chronic (long term) pain on your face giving bouts of excruciating pain. The pain is felt largely while touching your face like applying makeup or brushing your teeth etc. Even a small stimulation of the face can trigger this pain. The pain can be recurring and can cause mild attacks on your face. Trigeminal neuralgia affects elderly people largely and is more on women than men. The pain can be controlled by effective treatment and medications. Trigeminal neuralgia is a rare type of pain affecting people who are above 60 years and about 1 in every million people are affected.

Symptoms :

Trigeminal neuralgia can cause sudden episodes of shooting pain on your face that it can be felt as electric shock. The pain can be felt spontaneous when you touch the face. The pain would last for few seconds only but it may return again. For some people it can cause mild pain occasionally. Pain is triggered while you are touching the face for anything or for brushing your teeth. Many people describe the pain as though someone is stabbing with a knife on their face and piercing the skin.

The areas like cheeks, in and around the ears and jaws are worst affected with pain since the nerve passes through these areas. Pain is usually felt on one side of your face. For some people pain is focused in only one part like jaw or cheeks but for others it would spread widely. If not treated promptly, staggering pain is felt frequently and intensely over time.

Causes :

Intense sudden pain of trigeminal neuralgia occurs when the function of the trigeminal nerve gets disturbed. When the artery or vein gets in touch with the trigeminal nerve accidentally, it gets disrupted causing stabbing pain. Occasional contact of the artery with the nerve can put extra pressure on it thus interfering with its normal function. Aging is another factor that can cause trigeminal neuralgia. Having multiple sclerosis can also damage the myelin sheath covering of the trigeminal nerves causing intense pain. In rare cases formation of tumor on the trigeminal nerve can cause pain.

Risk Factors :

Old age is the primary risk factor for developing trigeminal neuralgia. For reasons unknown, women are more prone to get TN than men. The first attack or episode of pain comes without warning and may lasts for few seconds. The frequency of further attacks differs widely from one person to another. The pain may come and go on the same day or it can occur suddenly after a month or so. Nobody can predict when the next attack of pain would come back.

Complications :

As such trigeminal neuralgia would not cause any complications. However throbbing pain can interfere with your daily routine to large extent. You may ignore brushing your teeth or applying cream on your face due to the fear of pain. Hence you should not delay in taking treatment for trigeminal neuralgia.

Tests :

Your doctor can detect trigeminal neuralgia on listening to your symptoms. He may touch your face to verify where exactly pain has started. Further he may request for reflex test and neurological examination to know which branch of the nerve has been affected. To eliminate the possibility of multiple sclerosis he may order for imaging tests like CT/MRI scan.

Treatment :

For most of the people, trigeminal neuralgia pain can be managed by medications. But it can cause some adverse effect over long periods. In rare cases surgery is done for treating TN. Anticonvulsant medications like carbamazepine are prescribed for trigeminal neuralgia. After some years you may feel the pain again and your doctor may increase the dosage of the drug. These drugs can cause side effects like drowsiness and confusion.

Some doctors may prescribe muscle relaxing drugs like Gablofen or Lioresal for treating trigeminal neuralgia. In severe cases surgery is to be done to release the compression on the nerve. Microvascular decompressing surgery is done to remove the blood vessel from the trigeminal nerve region. A small incision is made behind the ear and a small hole is drilled on the skull. Your surgeon will remove any artery or vein that compresses the trigeminal nerve branch. This surgery can cause facial numbness or double vision or any other complications.

Another procedure called Gamma knife radioactive therapy is done wherein radiation is passed directly on the trigeminal nerve so that pain is not felt anymore on your face. This option is more effective and safe than surgery. If the patient gets back the pain again the same procedure is repeated. Your doctor may give you a shot of glycerol to damage the trigeminal nerve and blocking the pain. A small needle is sent into the base of skull through your face and sterile glycerol is injected directly on the nerve.

Balloon compression is another method for treating trigeminal neuralgia. A thin catheter is sent through the skull to locate the trigeminal nerve. A balloon is inserted to one end of the catheter which is then inflated to cause pressure on the trigeminal nerve to block the signals of pain. Now alternative therapies like acupuncture, vitamin or nutritional therapy and electrical stimulation are available for treating trigeminal neuralgia.

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