Occasionally, the compression is caused by a tumour, and often there is no obvious cause found. Other, rarer causes of trigeminal neuralgia include multiple sclerosis and strokes affecting the lower part of the brain. Your doctor will ask about the pain and perform a physical examination, testing the nerves of your head and neck. You may need to have an MRI scan of your head to check for any underlying cause of trigeminal neuralgia. Regular pain medicines are generally not helpful in treating trigeminal neuralgia because the episodes of pain are brief and recurrent.
However, anticonvulsant medications — the same medicines that are used to control seizures in people with epilepsy — have been found to be effective in relieving this type of nerve pain.
Your doctor will most likely prescribe an anticonvulsant such as carbamazepine for the initial treatment of trigeminal neuralgia.
Carbamazepine has been shown to be effective in relieving pain in people with trigeminal neuralgia. However, in some people, this medicine is not well tolerated because of side effects, or becomes less effective in controlling the pain over time. Other anticonvulsants can also be used, either as initial treatment or if carbamazepine is ineffective. Another medicine that can be used is baclofen, which is normally used to control muscle spasms.
Baclofen may be used in combination with an anticonvulsant. Surgery is an option if your trigeminal neuralgia is the result of a blood vessel compressing your trigeminal nerve. In this type of surgery, any blood vessels that are compressing the trigeminal nerve are removed or relocated. Surgery is more commonly performed in younger people who are in good overall health. There are also surgical procedures available that are aimed at destroying or damaging the affected part of the trigeminal nerve to reduce or eliminate the pain.
These include electrical current treatment, injections into the nerve, balloon compression and gamma-knife radiosurgery. There is a risk of permanent or temporary numbness of the face with these treatments. In most people, trigeminal neuralgia improves with treatment or goes into remission on its own. However, recurrences do occur, often after a long pain-free period.
Also, as with any ongoing painful condition, depression may occur, but there are treatments for depression that can help. Support groups can provide information, reassurance and support to people living with trigeminal neuralgia.
Of all treatment options, MVD has the highest success rate, and the lowest long-term recurrence rate, though it is a brain surgery. The lesion procedures are less invasive, but have their own risks, and are associated with some face numbness.
One approach is to put a needle into the nerve under x-ray guidance, and then to use a balloon, heat or glycerol to destroy some of the nerve fibers. This is called a rhizotomy. Another option is to target the nerve with very precise, high-dose beams of radiation. This is called radiosurgery. In radiosurgery, there is no open surgery at all. Radiosurgery works very well, but has the risk of leaving you with some face numbness.
In fact, all of the lesion procedures come with a risk for some face numbness; however, this is not a typical outcome after MVD. That said, there is no best surgical treatment for TN.
Each technique has risks and benefits. A neurologist or neurosurgeon can go over all the options with you, and help you decide what the best approach is for you. These attacks can occur in quick succession, in volleys lasting as long as two hours. Both forms of pain may occur in the same person, sometimes at the same time. The intensity of pain can be physically and mentally incapacitating.
The trigeminal nerve is one of 12 pairs of nerves that are attached to the brain. The nerve has three branches that conduct sensations from the upper, middle, and lower portions of the face, as well as the oral cavity, to the brain. The ophthalmic, or upper, branch supplies sensation to most of the scalp, forehead, and front of the head. The maxillary, or middle, branch stimulates the cheek, upper jaw, top lip, teeth and gums, and to the side of the nose. The mandibular, or lower, branch supplies nerves to the lower jaw, teeth and gums, and bottom lip.
More than one nerve branch can be affected by the disorder. Rarely, both sides of the face may be affected at different times in an individual, or even more rarely at the same time called bilateral TN. TN is associated with a variety of conditions. TN can be caused by a blood vessel pressing on the trigeminal nerve as it exits the brain stem. This compression causes the wearing away or damage to the protective coating around the nerve the myelin sheath.
Rarely, symptoms of TN may be caused by nerve compression from a tumor, or a tangle of arteries and veins called an arteriovenous malformation. Injury to the trigeminal nerve perhaps the result of sinus surgery, oral surgery, stroke, or facial trauma may also produce neuropathic facial pain. Pain varies, depending on the type of TN, and may range from sudden, severe, and stabbing to a more constant, aching, burning sensation. The intense flashes of pain can be triggered by vibration or contact with the cheek such as when shaving, washing the face, or applying makeup , brushing teeth, eating, drinking, talking, or being exposed to the wind.
The pain may affect a small area of the face or may spread. Bouts of pain rarely occur at night, when the affected individual is sleeping. TN is typified by attacks that stop for a period of time and then return, but the condition can be progressive. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur.
Eventually, the pain-free intervals disappear and medication to control the pain becomes less effective. Anticonvulsants were not originally designed to treat pain, but they can help to relieve nerve pain by slowing down electrical impulses in the nerves and reducing their ability to send pain messages. They need to be taken regularly, not just when the pain attacks happen, but you can stop taking them if the episodes of pain cease and you're in remission. Unless a GP or specialist tells you to take your medicine in a different way, it's important to increase your dosage slowly.
If the pain goes into remission, you can gradually reduce the dosage over the course of a few weeks. Taking too much too soon, or stopping the medicine too quickly can cause serious problems.
At the start, the GP will probably prescribe a type of anticonvulsant called carbamazepine , although a number of alternative anticonvulsants are available if this is ineffective or unsuitable. The anticonvulsant carbamazepine is currently the only medicine licensed to treat trigeminal neuralgia in the UK.
It can be very effective initially, but may become less effective over time. You'll usually need to take carbamazepine at a low dose once or twice a day, with the dose being gradually increased and taken up to 4 times a day until it provides satisfactory pain relief. You should speak to a GP if you experience any persistent or troublesome side effects while taking carbamazepine, particularly allergic skin reactions, as these could be dangerous.
Carbamazepine has also been linked to a number of less common but more serious side effects, including thoughts of self-harm or suicide. Immediately report any suicidal feelings to a GP.
If this is not possible, call NHS Carbamazepine may stop working over time. In this case, or if you experience significant side effects while taking it, you should be referred to a specialist to consider alternative medicines or procedures. There are a number of specialists you may be referred to for further treatment, including neurologists specialising in headaches , neurosurgeons, and pain medicine specialists.
In addition to carbamazepine, a number of other medicines have been used to treat trigeminal neuralgia, including:. None of these medicines are specifically licensed for the treatment of trigeminal neuralgia, which means they have not undergone rigorous clinical trials to determine whether they're effective and safe to treat the condition.
However, many specialists will prescribe an unlicensed medicine if they think it's likely to be effective and the benefits of treatment outweigh any associated risks. If your specialist prescribes you an unlicensed medicine to treat trigeminal neuralgia, they should inform you that it's unlicensed and discuss the possible risks and benefits with you.
The side effects associated with most of these medicines can initially be quite difficult to cope with. Not everyone experiences side effects, but if you do, try to persevere as they often diminish with time or at least until the next dosage increase. If medicine does not adequately control your symptoms or is causing persistently troublesome side effects, you may be referred to a specialist to discuss the different surgical and non-surgical options available to you.
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