When the trigeminal nerve comes into contact with an artery, venous loop or other lesions such a tumours, it can cause changes in the nerve. When the nerve becomes irritated in this way, it results in abnormal electrical activity to occur which causes pain.
This condition can also result in the absence of any compressive lesions. In this case demyelinating disorders such as multiple sclerosis.
Trigeminal Neuralgia Symptoms
The patient with trigeminal neuralgia will experience episodes of piercing or stabbing pain. This lancinating pain can spread over the face, the scalp, or into the gums and teeth.
It is a painful and debilitating condition. Common daily activities can trigger episodic pain. Activities such as touching, washing, or rubbing the face and brushing your teeth can lead to pain. Necessary everyday actions like eating and drinking can also cause neuropathic pain in worse conditions.
Causes
The cause of trigeminal neuralgia (TN) is not known yet. There are two types of TN and the causes of both are different from each other.
Primary Trigeminal Neuralgia
This type relates to the constriction of the nerve in the base head (junction of the spinal cord and brain). This happens when the trigeminal nerve or healthy artery or vein touches one another at the origin of the nerve.
Secondary Trigeminal Neuralgia
In this type cysts, multiple sclerosis, a tumour, injury related to the face, or any other medical condition causes damage to the myelin sheath. This causes the painful symptoms of trigeminal neuralgia.
Risk factors
- Individuals over the age of 50 are at higher risk chances than others.
- The ratio of suffering from trigeminal neuralgia in women to men is 3:2. This indicates that women are more prone to the disease.
- Multiple sclerosis has become a major risk factor for trigeminal neuralgia. In multiple sclerosis, the nerve is damaged due to the damage and hardening of the myelin which is a fatty substance. It is wrapped around the nerve fibre and protects it.
Trigeminal Neuralgia Diagnosis
The diagnosis of trigeminal neuralgia is clinical. This means that we diagnose the condition by reviewing signs, symptoms, the history of the disease, and the location of the pain.
It is possible to conduct further testing to uncover an obvious cause. This involves performing MRI scans.
Trigeminal Neuralgia Treatment
There are few treatment options which include:
- Medication: Doctors will modify the dose according to the response of the patient to the drug.
- Carbamazepine: This is the first choice of drug for treating trigeminal neuralgia. It is an anticonvulsant drug. If the patient does not start recovering from this medicine then it creates a doubt whether the patient is suffering from trigeminal neuralgia or not. In the starting phase, it decreases the pain. The effect of the drug reduces after some time.
- Gabapentin: This drug is mostly preferred for migraine and epilepsy but is also helpful in trigeminal neuralgia.
- Oxcarbazepine: Nowadays, it is known as the first-line treatment for the disease. It is a newer type of medicine. It is an isomer of carbamazepine but with fewer side-effects.
- Other medications which can be given to treat the disease are amitriptyline, phenytoin, clonazepam, baclofen, nortriptyline, valproic acid, sodium valproate, pregabalin, opioids, lamotrigine, and topiramate.
- Performing radiofrequency treatment
- Performing micro neurosurgery to remove any tumours or abnormal blood vessel loops. This method is used when the non-surgical method does not help treat the disease. The surgery is classified into two groups
- Open cranial surgery: If the disease is due to excessive pressure on the trigeminal nerve caused by a blood vessel, then open cranial surgery is performed. This condition is diagnosed by MRI.
- Lesioning procedures: This is done when something injures the trigeminal nerve, then it starts to cause pain.
- Performing stereotactic radiosurgery
Recovery
The recovery depends on the type of surgical procedure.
- In percutaneous procedure: Instant pain relief can be experienced from this procedure. The patient may feel the loss of sensation on the face. According to the NYU Langone report, patients better tolerate the loss of sensation than the pain of the condition.
- In gamma knife surgery: The reduction in pain takes weeks to months. The patient has to undergo follow-up treatment after three to six months.
- Microvascular decompression surgery: It is a fast relief procedure. Post the surgery, the doctor advises the medicines for two to four weeks. This helps to reduce swelling and discomfort and helps to decrease post-surgery infections. The doctor will decrease the dose of medicine until at last, the medicines are stopped. After ten days the sutures are removed from the treated area. Patients get back to daily activities post one month of surgery.
Research
Nowadays we use both complementary and alternatives therapies to treat trigeminal neuralgia. There is no comparison between the two and which therapy suits best to treat trigeminal neuralgia. The objective of this comparative study is to check and rate the efficacy and safety of these therapies.
Frequently asked questions
By what other names trigeminal neuralgia is known?
It is also called Tic douloureux, TN, facial pain, Prosopalgia, trifacial neuralgia, prostatodynia, Fothergill’s disease, prosoponeuralgia.
What are trigger factors or trigger points for Trigeminal neuralgia?
The starting of attacks can be triggered by just touching the face. Some trigger points on the face include:
- Lower and upper gum
- Ala of the nose
- Upper lip
- Front of the ear
- Forehead
Is the pain that severe?
Yes, it is. The trigeminal neuralgia pain beats the pain of any other diseases. The patients have described TN pain as a “deadly curse”, “Death be better than suffering”, “Pain of thousand knives piercing the face”.
Which trigeminal nerve division is most commonly affected?
In about 40% of the patients, the V2-V3 division. In only 10% of the patients, all three branches are affected.
