Trigeminal Neuralgia Treatment, Symptoms, Causes, and Types

A condition known as trigeminal neuralgia causes an electric shock-like pain to radiate down one side of the face. This type of persistent pain affects the trigeminal nerve, which carries sensations from the face to the brain. Trigeminal neuralgia patients may experience agonising pain when even minor facial stimulation, such as tooth brushing or applying makeup, occurs.

At first, you can encounter brief, mild attacks. Trigeminal neuralgia, however, has a propensity to worsen with time and cause longer, more frequent episodes of intense pain. Trigeminal neuralgia is more common in women than in men, and it is more likely to affect those over the age of 50.

Trigeminal neuralgia is not necessarily an indication that you will live in constant pain due to the variety of treatments that are accessible. In most cases, medicines, injections, or surgery are effective treatments for trigeminal neuralgia.

What Is Trigeminal Nerve?

The trigeminal nerve is one of the 12 pairs of nerves that connect to your brain. It is responsible for sending messages of touch and pain from your face and head to your brain. Each of the trigeminal nerve's three branches is responsible for sending nerve impulses to a different part of your face:

• The ophthalmic branch-The upper part of your face, particularly your forehead.
• The maxillary branch- The middle of your face  where your cheekbones, nostrils, and top lip are located.
• The mandibluar branch- your lower face, which includes the area around your jaw and lower lip.

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Types Of Trigeminal Neuralgia

Trigeminal neuralgia comes in two primary varieties:

• Typical Trigeminal neuralgia (Type 1)-  Sharp, acute, intermittent pain episodes are probably what you'll encounter. You may feel pain and/or a burning sensation all over your face for anywhere between a few seconds and two minutes. Between episodes, there will be times of painlessness, but this may last for as long as two hours.

• Atypical trigeminal neuralgia (Type 2)-  Less severe and intense, but more ubiquitous, will be this. Along with continuous aches and pains, you'll probably have constant agony, particularly stabbing and/or burning feelings. The symptoms of atypical trigeminal neuralgia could be more challenging to manage.

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Symptoms Of Trigeminal Neuralgia

Trigeminal neuralgia symptoms may exhibit one or more of the following patterns:

• Periods of intense, shooting, or jabbing pain that might feel electric shock-like
• Attacks of pain that occur without warning or that are brought on by actions such as touching the face, chewing, speaking, or brushing one's teeth.
• A few seconds to several minutes long pain attacks
• face spasms' accompanying discomfort
• Some persons find intervals of pain relief between bouts of multiple attacks that last days, weeks, months, or longer.
• Trigeminal nerve-supplied areas such as the face, jaw, teeth, gums, and lips, as well as the eye and forehead less frequently, can all experience pain.
• one side of the face at a time experiencing pain
• Whether pain is localised or dispersed throughout the body
• Occasionally, pain will arise when you're sleeping at night
• Attacks that gradually increase in severity and frequency

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Causes Of Trigeminal Neuralgia

Trigeminal nerve function is compromised in trigeminal neuralgia, commonly known as tic douloureux. The trigeminal nerve, which is found at the base of the brain, usually causes problems when an artery or vein or another typical blood vessel comes into contact with it. Pressure from this contact causes the nerve to sustain injury.

Trigeminal neuralgia can have a variety of additional possible reasons in addition to the more frequent cause, which is compression by a blood artery. Some might be connected to multiple sclerosis or a condition that damages the myelin sheath encasing particular nerves, such as lupus. Additionally, a tumour pressing against the trigeminal nerve might result in trigeminal neuralgia.

Some people may develop trigeminal neuralgia due to a brain lesion or other problems. Trigeminal neuralgia may also result from facial trauma, surgical wounds, or strokes.

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 Which Factors Can Trigger Trigeminal Neuralgia?

Trigeminal neuralgia has many potential triggers, including the following:

• Shaving
• Facial contact
• Food
• Drinking
• brushing teeth
• Talking
• Putting makeup on
• The breeze blowing slightly on your face
• Smiling
• Facial washing

Diagnosis Of Trigeminal Neuralgia

Your doctor will determine whether you have trigeminal neuralgia mostly based on how you describe the pain, which may include:

• Type. The pain associated with trigeminal neuralgia is sudden, shock-like, and temporary.
• Location. Your doctor can examine the painful areas of your face to discover whether the trigeminal nerve is involved.
• Triggers. Eating, speaking, softly touching your face, and even feeling a cool wind are common trigeminal neuralgia pain triggers.
• Your doctor may run several tests, such as the following, to determine whether you have trigeminal neuralgia and to determine the underlying causes of your condition:
• A neurological examination. By feeling and examining different regions of your face, your doctor can determine the precise site of the pain and, if you look to have trigeminal neuralgia, which branches of the trigeminal nerve may be afflicted.
• Magnetic resonance imaging (MRI). Your doctor might do an MRI of your head to determine whether multiple sclerosis or a tumour is the source of your trigeminal neuralgia. Your doctor might every now and then inject a dye into a blood vessel to highlight blood flow while inspecting the arteries and veins.

Given the wide range of conditions that could be the cause of your facial pain, a correct diagnosis is essential. Your doctor may ask for more testing to rule out other conditions.

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Treatment Of Trigeminal Neuralgia

Some patients with the condition, nevertheless, may eventually stop responding to treatment or experience negative side effects. For certain patients, there are further trigeminal neuralgia therapies including injections and surgery.

Your doctor will treat the underlying problem if it's determined that your condition is brought on by another factor, such as multiple sclerosis.

Medications

Medications that lessen or block the pain signals that are transmitted to your brain are frequently prescribed by your doctor to treat trigeminal neuralgia.

• Anticonvulsants. Carbamazepine (Tegretol, Carbatrol, and other brands) is frequently used to treat trigeminal neuralgia, and it is effective. Another anticonvulsant drug that may be used to treat trigeminal neuralgia is oxcarbazepine.
• Trileptal, Oxtellar XR, valproate, phenytoin (Dilantin, Phenytek, Cerebyx), and lamotrigine (Lamictal). Clonazepam (Klonopin), topiramate (Qsymia, Topamax, and others), gabapentin (Neurontin, Gralise, Horizant), pregabalin (Lyrica), and others may also be used.
• If the anticonvulsant you're taking starts to lose its effectiveness, your doctor may increase your dose or change to a different type. Consequences of anticonvulsants can include nausea, fatigue, confusion, and dizziness.
• Before you start taking carbamazepine, genetic testing may be indicated because it can have a major adverse drug reaction in some people, especially those with Asian ancestry.
• Anti-spasmodic drugs. It is possible to administer the muscle relaxant baclofen (Gablofen, Lioresal, Ozobax) either by itself or in conjunction with carbamazepine. Uncertainty, nausea, and drowsiness are potential adverse effects.
• Injections of Botox. OnabotulinumtoxinA (Botox) injections may lessen trigeminal neuralgia pain in those for whom medication is no longer effective. Before this treatment is widely used for this ailment, more research must be conducted.

Surgery

Trigeminal neuralgia surgical options consist of:

• Decompression of small blood vessels. In order to prevent the trigeminal nerve from malfunctioning, this technique includes shifting or eliminating blood veins that are in close proximity to the trigeminal root. On the side of your pain, your doctor makes an incision behind the ear to do microvascular decompression. Your surgeon will next insert a soft cushion between the trigeminal nerve and the arteries through a small hole in your skull and relocate any arteries that are in touch with the nerve.
• If the vein is pressing against a nerve, your surgeon may decide to remove it. Doctors may do neurolysis during this procedure if there are no arteries pressing against the trigeminal nerve.
• Microvascular decompression can successfully reduce or eliminate pain for many years still three out of ten people will experience a recurrence of their pain within 10 years. Reduced hearing, face numbness or weakness, stroke, or other issues are risks of microvascular decompression. There is typically no post-procedure facial numbness in patients who have this operation.
• Gamma knife stereotactic radiosurgery of the brain. A surgeon uses radiation during this procedure to specifically target the trigeminal nerve root. In this procedure, the trigeminal nerve is damaged in an effort to reduce or eliminate pain.Relief gradually begins and may continue for up to a month.
• Pain relief through brain stereotactic radiosurgery is effective for the majority of patients.However, there is a chance of recurrence, typically within 3 to 5 years, as with all treatments. If the discomfort returns, you can try the operation again or try an alternative approach. Facial numbness is one of the most frequent side effects and may develop months or years after surgery.
• Trigeminal neuralgia may be treated by rhizotomy among other methods. Your surgeon performs a rhizotomy, which causes partial facial numbness, to lessen pain.Various rhizotomy types include:
• Infusion of glycerol. During this procedure, your doctor will insert a needle into the base of your skull through your face. The trigeminal cistern, a little sac of spinal fluid containing the trigeminal nerve ganglion, the location of the trigeminal nerve's three branching points, and a portion of its root, will be the location where your doctor inserts the needle.
• Your doctor administers a little injection of sterile glycerol to injure the trigeminal nerve and inhibit pain signals.Pain is frequently reduced by this process. However, many suffer from facial numbness or tingling, and some persons report a subsequent recurrence of pain.
• Inflation of a balloon. By inserting a hollow needle into your face and guiding it to the trigeminal nerve's route via the base of your skull, your doctor will execute balloon compression. Your doctor will then thread the catheter—which has a balloon—through the needle. The balloon is inflated by your doctor to a pressure that damages the trigeminal nerve and impairs pain perception.
• Using balloon compression, the majority of patients may successfully manage their discomfort, at least temporarily. The majority of patients go through this operation with at least some temporary facial numbness.
• Lesioning with radiofrequency heat. This treatment specifically kills pain-related nerve fibres. A hollow needle is inserted into your face while you are unconscious by your surgeon, who then directs it to a section of the trigeminal nerve that passes through a hole in the base of your skull.

Your surgeon will temporarily awaken you from sedation after the needle is in place. An electrode is placed through the needle by your surgeon, who then passes a little electrical current through the electrode's tip. You'll be asked to say where and when you experience tingling.

Once the neurosurgeon locates the portion of the nerve that is bothering you, you are put back under sedation. The electrode is then heated until the nerve fibres suffer a lesion (injury). If your pain is not reduced, your doctor may do further lesions.

Some temporary face numbness following radiofrequency thermal lesioning is usual. Pain may recur after three to four years.

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