Trigeminal Neuralgia: What Is It?
Often shortened to TN, Trigeminal neuralgia is a painful and chronic condition that affects the trigeminal nerve. This is responsible for carrying the feeling of pain between the brain and face, along with other sensations. Patients suffer intense pain around their face or just part of it.
Just mild stimulation from shaving or brushing the teeth can lead to the pain and patients describe it as feeling like they have been stabbed or suffering from electric shocks. There are times when the pain is short but these can become more frequent and last for much longer periods of time. For most with TN the pain comes and goes in cycles. There will be a couple of days or weeks where there is pain and then none. It is generally progressive and that feeling of pain can constantly be there.
It can take a long time for diagnoses since there is no single test for it. The process of treatment will depend on the severity and reason for it. There are options to treat the symptoms and the amount of time that they happen but there are times that surgery is a necessity.
Trigeminal Neuralgia Causes
The cause is not found in the majority of causes but these are the possibilities:
- Tumor or swollen blood vessel on the nerve
- Multiple sclerosis (MS), which damages the myelin sheath – the coating that protects the nerves
- Getting older – those over 50 are more at risk of developing TN
It is possible for anyone to suffer from it but women are more commonly the patients.
Trigeminal Neuralgia Symptoms
The pain is usually described as electric shocks as it comes in spasms. It usually happens on only one side and can happen simply because of a touch or sound. Many routine factors can cause the pain, including:
- Brushing the teeth
- Touching the face
- Applying makeup
- Drinking and eating
- A slight breeze
Some people will find that the pain is only there for a few minutes or seconds but others suffer for days or weeks, and in some cases months, and it will then go into remission for a short period.
It can get worse over time, in frequency and severity. It can also lead to a constant ache or pain in the body.
Diagnosing Trigeminal Neuralgia
Since there is no separate test for diagnosing TN, it can take time. There are a number of factors affecting the diagnosis, including the location, type and trigger of the pain. Your doctor will need to check your medical history and do a physical exam first and will then want to run other tests as there are other conditions with very similar symptoms, including post-herpetic neuralgia that affects the skin and nerve fibers and cluster headaches.
You will need to go through a neurological exam and part of that involves touching where the pain is. This helps the doctor see the part of the nerve that has been affected. You may also have a magnetic resonance image taken (MRI) to determine if multiple sclerosis is the problem.
Preparing for Your Appointment
You should track your symptoms in a daily journal. Make sure you detail the triggers and the length of time they last. It is also important to list any home remedies you have tried and the medications (prescription or over the counter) and supplements you are on. Make a note of any allergies that you know about.
You should also go through all the surgeries, procedures, injuries and treatments you have had around the area.
Trigeminal Neuralgia Treatment
It is possible to use medication for pain relief and limit the attacks. Some of the common options include:
- Anti-seizure medications to block the nerve from firing the pain
- Muscle relaxants
- Tricyclic antidepressants
In most cases, patients respond positively to the medication but there are times that the pain can return. When this happens, surgery is a consideration. Some of the more common surgical options include:
This is an outpatient procedure and involves a needle being inserted into the face at the base of the skull. The surgeon will guide the needle into the spinal fluid that is in a small sac around the trigeminal nerve root. This needle releases some glycerol to help block the pain by damaging the nerve.
Computer imaging is used so highly focused radiation beams are delivered to the nerve’s root. This is performed without any anesthesia because it is so painless for the TN sufferer.
Radiofrequency Thermal Lesioning:
This is another outpatient procedure but done with general anesthesia. A hollow and long needle is placed into the trigeminal nerve to send an electric current to it. The patient is then woken so he can help the surgeon find where the pain is originating from in the nerve. Once the pain is found, a heated electrode damages the nerve to stop the pain.
A targeted approached is used to deliver radiation to the nerve and destroy it. This is becoming extremely popular because it is so effective and precise. It is also one of the safest options compared with the other surgical options.
There are other surgical options available, including relocating the blood vessels placing the pressure and severing the nerve completely. Each of the surgical options have the risk of permanent numbing within the face and the pain can return in the future.
It is worth talking to your doctor about your options to understand all the risks and benefits of each treatment option. Your doctor will be able to evaluate your personal preference, symptoms and medical history to help you choose the best form of treatment for you.
The Future for TN Sufferers
With the proper treatment, it is possible to manage TN. The pain may never actually go away completely though. This is not a fatal condition but it can cause mental problems and is debilitating. When the reason isn’t found, many doctors will recommend medication, nutritional therapy, meditation, acupuncture and other complementary techniques. You should always talk to your doctor about these alternate options to make sure they will not interact with any medication you are already on.