Definition (Trigeminal neuralgia): It is aneuropathic disorder characterized by episodes of intense pain in the face, originating from the trigeminal nerve.It has been described as among the most painful conditions known.
Trigeminal neuralgia is a condition which is characterized by severe, sharp, stabbing facial pain in the territor of one or
Trigeminal neuralgia (TN) is a chronic, painful condition involving the trigeminal nerve, the nerve responsible for carrying the sensation of pain and other sensations from the face to the brain. The condition causes intense pain in part or all of the face.
The pain can be brought on even by only mild stimulation of the face (such as brushing your teeth or shaving) and is described as feeling like electric shocks or stabbing. People with TN may initially have short, mild instances of pain, but over time experience longer, more frequent attacks of intense pain. Most people with TN experience symptoms in cycles. Pain comes and goes for days or weeks, then subsides. In some cases, the condition becomes progressive and the pain is always present.
There is no specific test for TN, so diagnosis can take time. Treatment depends on the cause and severity of the condition. Several medications are available to provide relief from pain and to decrease the number of episodes. Surgery is sometimes required
In many cases, the cause of TN is never found. However, known causes include:
• a swollen blood vessel or tumor that puts pressure on the nerve
• multiple sclerosis (MS), a condition that damages the protective coating around nerves (myelin sheath)
• aging—the risk of TN increases after age 50
Although anyone can get TN, it is more common among women than men (NINDS).
The pain of TN can come in sharp spasms that feel like electric shocks. The pain generally occurs on one side of the face and may be brought on by sound or touch. The pain can be triggered by something as routine as:
• brushing your teeth
• putting on makeup
• touching your face
• eating or drinking
• a breeze on your face
There is no single test that can diagnose TN. Diagnosis will depend on the type and location of the pain, and factors that trigger your pain will also be considered. Your doctor will first evaluate your medical history and perform a physical exam before running further tests to rule out other conditions with similar symptoms, such as cluster headaches or post-herpetic neuralgia, a painful condition that affects nerve fibers and skin.
Your doctor will perform a neurological exam that will include touching your face at the location of the pain, which can help your doctor determine which part of the trigeminal nerve is being affected. Your doctor may order magnetic resonance imaging, commonly known as an MRI, to scan your head. This test can help determine whether multiple sclerosis is causing pain.
Medication can provide relief from pain and reduce the number of attacks. Some commonly prescribed drugs include:
• muscle relaxants
• anti-seizure medications (drugs that block nerve firing)
• tricyclic antidepressants
While most cases of TN respond to medication, sometimes pain will stop responding to medication and severe symptoms can return. In those cases, surgery may be an option. Common surgical procedures used to treat TN include:
During this outpatient procedure, your doctor will insert a needle through your face and into the base of your skull. The needle is guided to a small sac of spinal fluid that surrounds the root of the trigeminal nerve. Once the needle is in place, a small amount of sterile glycerol is released, damaging the nerve and blocking pain.
This procedure uses computer imaging to deliver highly focused beams of radiation to the root of the nerve. This procedure is painless and is usually performed without anesthesia.
Radiofrequency Thermal Lesioning
This outpatient procedure is performed under general anesthesia, and uses a long, hollow needle to guide an electrical current to the trigeminal nerve. The patient is awakened to assist the doctor in identifying the exact location of the origin of the pain. Once the site of the pain is identified, the electrode is heated and it destroys the nerve.
This procedure uses a targeted approach for delivery of radiation that destroys the trigeminal nerve. It is gaining in popularity because of its precision, effectiveness and the fact that it is considered safer than other surgical treatments.