Overview: Trigeminal Neuralgia
The trigeminal nerve is one of the main nerves on each side of the face. These nerves are responsible for carrying the sensations of pain and touch to the brain from areas of the face, such as the teeth and mouth. When neuralgia occurs, even a mild sensation (like brushing teeth) can cause intense pain.
In 90 percent of reported cases, the main cause of trigeminal neuralgia is contact or pressure from an artery or vein resulting in nerve malfunction. Although rarer, trigeminal neuralgia can occur due to an underlying cause, such as a tumor, skull abnormality or multiple sclerosis.
The literal meaning of neuralgia is pain originating from a nerve. The pain often occurs in jolts and can be severe. The most commonly affected areas are the jaw and cheeks; episodes of pain in and around the forehead are not as prevalent. Trigeminal neuralgia pain generally occurs on one side of the face–rarely on both sides. The pain is sharp and brief; it has been compared to being pierced by a knife in quick succession. After one jolt, a dull ache remains in the affected area which soon vanishes. The frequency of pain tends to vary; however, constant pain is never a symptom of trigeminal neuralgia.
Specific areas on the face can be trigger points; a gentle touch or even a slight breeze can generate sharp pain in the area. This makes routine tasks, such as shaving, applying makeup and eating difficult.
Carbamazepine, a medication used to treat epilepsy, quiets nerve impulses, so it usually works well to manage the pain of Trigeminal Neuralgia, too. The dose varies from person to person as it is dependent upon the intensity of pain. Other medications also work by quieting nerve impulses. They include baclofen, gabapentin, oxcarbazepine, or lamotrigine. A combination of medications (no more than two) is often used in cases where one does not help. Pain medications are not effective for treating neuralgia.
If other treatments do not offer any relief, two types of surgeries are recommended:
This surgery alleviates the pressure on the nerve resulting in long-term positive results. The base of the nerve inside the brain is targeted. General anesthesia is required during this surgery.
Also known as stereotactic radio-surgery, this treatment targets and destroys the nerve root. Although this is a less invasive treatment with fewer risks than decompression surgery, it is a short-term treatment.