Trigeminal neuralgia

You don’t expect to get a shock-like extreme pain from doing a simple activity like brushing, or a strong burning sensation on your left cheek when washing your face. However, these experiences may be common in people who have a condition called trigeminal neuralgia. It is named so because it involves the trigeminal nerve. Trigeminal nerve is a nerve that carries sensation from the face to the brain, and is also responsible for certain motor functions such as chewing, biting and swallowing.

Introduction to trigeminal neuralgia

Trigeminal neuralgia (TN) is also termed as Tic Douloureux. Terminal neuralgia is a recurring, excruciating, agonizing, swift, and intense pain ever known to man. It comes on one side of the face in small bursts and spasms lasting for a few seconds, and maybe followed by several such types of bouts of pain.

Before the episodes begin one may experience a sense of numbness or tingling. These flashes of pain can be triggered by slight touch to the face such as shaving, make-up or brushing teeth or washing face.

The vibrations created due to talking, eating, drinking or slight wind may spark the flare-up of pain. There may be periods of remission during which the pain is completely absent and the periods of remission may extend for days, months or years. Trigeminal Neuralgia occurs commonly in women and in persons above the age of 50. This disorder could be hereditary.

Trigeminal neuralgia occurs when the trigeminal nerve is injured or damaged. It could occur when there is pressure on the root of the trigeminal nerve either from a blood vessel or from a tumor (abnormal outgrowth of cells). It can also occur if the sheath that covers trigeminal nerve is damaged or destroyed.

Certain diseases like Multiple Sclerosis (inflammatory condition of the nerve sheaths) may damage trigeminal nerve, which generally happens in the advanced stages of Multiple Sclerosis.

Injury to the trigeminal nerve may happen during any facial or dental surgeries or due to infections. In some rare cases, TN maybe inherited and can run in certain families.

Though anybody can suffer from trigeminal neuralgia, following personnel may be at higher risk of suffering from trigeminal neuralgia.

  • People above the age of 50

  • Women

  • Having a family history of trigeminal neuralgia

Symptoms of terminal neuralgia

A list of terminal neuralgia symptoms are mentioned below. They are:

  • Severe shooting pain

  • Constant aching

  • Burning feeling

  • Pain affecting the side of the face

  • Attacks that become more frequent

  • Pain while chewing, speaking and brushing

The diagnosis of Terminal Neuralgia is made primarily based on the nature of pain experienced. The physician may ask whether the pain is sudden, sharp and excruciating, and which part of the face is affected.

These details help the doctor to identify which trigeminal nerve is involved. Other details like whether the pain is triggered by simple touching and due to vibrations caused by regular activities such as drinking, eating, swallowing, brushing teeth or by the breeze of the wind would also be needed.

In order to confirm the diagnosis, the following tests may have to be undertaken.

  • Facial examination: The doctor may touch and examine various parts of your face so as to confirm if any branches of the trigeminal nerve are involved.
  • Magnetic resonance imaging (MRI):  Instruments which use magnetic field may be used to scan if your trigeminal nerve or its branches are injured or damaged.

If needed be, your doctor may require you to undergo some more specific tests if any tumors are suspected to be causing the injury to the trigeminal nerve.

The initial option of trigeminal neuralgia treatment is medications. Most people respond to these medications. But over time these medicines may not be effective or may cause unpleasant side effects. In such conditions other options of treatment include surgery and other procedures.

Medications are given to block the signals being sent to the brain. Your doctor may prescribe anticonvulsants (medicines that reduce seizures), antispasmodics (medicines that reduce the pain spasms) and antidepressants (medicines that reduce the sensitization to pain).

Your doctor may prescribe a combination of medicines. In order to stop painful hurting of the trigeminal nerve, your doctor may prescribe alcohol injections to numb the area, and block the nerve.

The objective of the surgical option could be to reduce the pressure on the trigeminal nerve from the blood vessels or repair the damage caused to the trigeminal nerve. The surgical procedures include:

  • Gamma knife radiosurgery (GKR):The procedure involves application of gamma rays (high frequency electromagnetic radiation) to trigeminal nerve to correct TN. The procedure is painless and done without anesthesia. Less than 5% of the patients may experience loss of facial sensation.

  • Microvascular decompression:The procedure involves removal of the blood vessel that is causing the pressure on trigeminal nerve. Your doctor may make a surgical incision behind the ear to reach the part of the trigeminal nerve that is being affected and direct or remove the blood vessel causing the injury. The surgeon may place a pad between the trigeminal nerve and the blood vessel to relieve the pressure on the trigeminal nerve.

  • Glycerol injection:A glycerol injection may also be administered to the base of the trigeminal nerve so as to make it insensitive to perceive the pain. This procedure may result in the loss of facial sensation and TN could recur again.

  • Balloon compression:The surgeon introduces a balloon through a catheter to the base of the trigeminal nerve and inflates it so as to make the trigeminal nerve insensitive to the signals so that the patient can not perceive the pain. Some may experience either partial or complete facial loss of sensation.

  • Rhizotomy (Severing the nerve):The surgeon may adopt the procedure to partially severe trigeminal nerve at the base so as to incapacitate trigeminal nerve or its branch. The damage is permanent and the patient could lose facial sensation permanently.