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Trigeminal Neuralgia

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  3. Trigeminal Neuralgia

Overview of Trigeminal Neuralgia

Trigeminal neuralgia is a medical condition in which the person suffers from damaged trigeminal neuralgia. The trigeminal nerve is responsible for carrying the sensation from the facial muscles to the brain. People who have trigeminal neuralgia tend to suffer from episodes of excruciating pains while doing simple everyday activities such as chewing or brushing. Trigeminal neuralgia may start initially as mild and short-lived attacks but it can progress for a longer period. Women are more at risk of developing trigeminal neuralgia and people who are above the age of 50 are more susceptible to this disease. 

 

Signs and Symptoms of Trigeminal Neuralgia

Given below are some signs and symptoms of trigeminal neuralgia: 

  1. Episodic pains that feel like electric shocks 
  2. Triggered surges of pain on doing simple activities such as touching, chewing, or brushing 
  3. Pain that lasts from a few seconds to several minutes 
  4. Sudden periods of relief between episodes of pain 
  5. Several episodes of attacks that last longer than a few seconds and span over months 
  6. Pain that originates from a specific corner and then spreads over 
  7. Pain that usually affects one side of the face 
  8. Attacks whose intensity grows with time 
  9. Aching sensations that are accompanied by a feeling of burning 

Triggers for Trigeminal Neuralgia 

The following are the triggers for trigeminal neuralgia:

  1. Eating 
  2. Shaving 
  3. Touching the face 
  4. Talking
  5. Breeze on the face 
  6. Showering 
  7. High blood pressure
  8. Cold weather 
  9. Alcohol drinking 
  10. Washing your face 
  11. Stress

Types of Trigeminal Neuralgia

There are two main types of trigeminal neuralgia. 

  1. Typical or Type 1 Trigeminal Neuralgia

 People who are suffering from this type of Trigeminal Neuralgia tend to feel episodes of sharp and sporadic pains that last from seconds to two minutes. There can be breaks but the pain can last for two weeks. 

  1. Atypical or Type 2 Trigeminal Neuralgia

In this type of trigeminal neuralgia, the pain is less excruciating but is more widespread. Patients who are dealing with type 2 face more difficulty to control the symptoms. 

Causes of Trigeminal Neuralgia

Blood vessels pressing against the root of the trigeminal nerve are the leading cause of trigeminal neuralgia. Multiple sclerosis and tumors are the reasons for this pressure buildup on the trigeminal nerve. 

Other notable causes are:

  1. Tumors against the trigeminal nerve 
  2. Due to an injury or a surgical procedure, physical damage to the nerve 
  3. Previous medical or family history 
  4. Trigeminal neuralgia mostly appear at the later stages of multiple sclerosis
  5. Shingles which is a common viral infection can also cause trigeminal neuralgia 
  6. Arterial deformities can put pressure on the trigeminal nerves
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Risk Factors of Trigeminal Neuralgia

The risk factors for trigeminal neuralgia are:

  1. Women who are above 50 
  2. Improper or excessive dental risk 
  3. Injury or a fatal blow to the face 

Trigeminal Neuralgia Complications

The following are the complications of trigeminal neuralgia:

  • Double vision 
  • Blurry vision 
  • Jaw dislocation
  • Loss of corneal reflex
  • Troublesome numbness

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Prevention

The preventive measures for trigeminal neuralgia are not concrete. But the following methods do help ease up the pain:

  1. Eating soft and easy-on-the-palate foods 
  2. Refrain from eating too cold or too hot foods
  3. Try to use cotton pads while washing your face
  4. Rinse your mouth with lukewarm water after eating if brushing is painful 
  5. Avoid triggers
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Diagnosis

The diagnosis of this disease starts with a physical exam. The doctor will also ask questions about your previous medical records. There is currently no diagnostic test that can single out the onset of trigeminal neuralgia thus finding the source of pain is the key.

Depending upon the situation of pain the doctor may also recommend you some lab tests such as MRI Tests or CT scans. These diagnostic tests are crucial to rule out the presence of a tumor or a blood vessel blockage.

Treatment of Trigeminal Neuralgia | When to Consult a Doctor

The treatment methodologies for trigeminal neuralgia are as follows:

  1. Medications

Even though medicines are mostly administered to patients with trigeminal neuralgia. But there is a risk of side effects and thus doctor recommends surgery. 

Anticonvulsants

These drugs help to block the sensations of pain from the face to the brain. They are highly effective while calming the pressured nerves. 

Best examples of these:

  • Phenytoin 
  • Gabapentin
  • Topiramate 
  • Valproic acid 
  • Lamotrigine

Side Effects of Anticonvulsant 

Given below are some of the side effects of using anticonvulsants:

  • Fatigue 
  • Blurry vision 
  • Nausea
  • Confusion 
  • Hallucinations 
  • Drowsiness 
  • Suicidal thoughts 

  1. Antiplasticity Agents 

These are given as combined therapy with anticonvulsants. Baclofen is a famous muscle-relaxing agent. 

  1. Alcohol Injection 

Alcohol injections are administered to the painful part of the face. It temporarily numbs the area. 

  1. Surgery 

Surgery is an effective remedial treatment for trigeminal neuralgia. The surgeon either damages the nerve so that the pain is blocked or they stop the pressure buildup on the nerve. 

In case of nerve damage, the patient may suffer from facial numbness for some time. The symptoms can return after some time. 

Some surgical options are given below:

  • Microvascular Decompression 

This invasive procedure involves either the removal or relocation of the nerve that is putting pressure on the trigeminal nerve.

  • Percutaneous Glycerol Rhizotomy

PGR is a procedure in which the needle is inserted through the face into the skull. With the help of the latest imaging techniques, the needle is guided to the joining points of the trigeminal nerve. Sterile glycerol is injected and after some time the pain pathway is blocked. 

  • Percutaneous Stereotactic Radiofrequency Thermal Rhizotomy 

Electrical signals are used in this method to damage the nerves that are linked to the painful sensation. Patients who undergo this surgical procedure tend to feel facial numbness afterward. 

  • Partial Sensory Rhizotomy 

The surgeon can either rub the nerve or severs it. This leads to permanent numbness of facial muscles. 

  • Gamma-Knife Radiosurgery 

The roots of the trigeminal nerve are exposed to a high dose of gamma radiation. This leads to gradual nerve damage and pain reduction. GKR is an effective treatment method for patients with trigeminal neuralgia.

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