What is trigeminal neuralgia?
Trigeminal neuralgia, commonly known as tic douloureux, is a condition caused by severe facial pain that can interfere with daily tasks. Simple actions like chewing, talking, smiling, brushing your teeth, or shaving can cause momentary bouts of severe pain. It often affects only one side of the face and usually affects the right side more than the left. Although there is no permanent cure for trigeminal neuralgia, there are treatments to reduce the excruciating pain.
Anticonvulsant medicines are often the initial course of medication, and surgery could be an effective alternative if a patient fails to respond to medication or develops severe side effects.
Symptoms
Some symptoms are restricted to the cheek and jaw area, including-
- Numbness and a tingling sensation
- Short bursts of severe pain
- Regular aches and pains
Other symptoms include-
- Short-term jolts of pain, a stabbing pain
- Simple activities like chewing or talking bring on out-of-nowhere episodes.
- A burning sensation all over one side of the face.
When To See a Doctor?
Suppose you experience sudden severe facial pain, which is persistent and recurs frequently and won't subside with over-the-counter medicines. In that case, it is advised to consult the doctor immediately to avoid any severe side effects of the conditions.
Causes
A compressed and inflamed trigeminal nerve can cause trigeminal neuralgia. In most cases, the trigeminal nerve is compressed because of swollen blood vessels which come in contact with it.
A layer of lipids, proteins, and other substances called the myelin sheath surrounds nerve fibers, providing insulation and protection and boosting electrical impulses. This condition can also be spurred on by several factors, including multiple sclerosis and other diseases that harm the myelin sheath, such as optic neuritis or Devic's disease.
- Blood Vessels : The most common cause of trigeminal neuralgia is compression of the trigeminal nerve by the blood vessels which surround or cover the nerve.
- Brain Tumors and cysts : Brain Tumors and cysts: Cysts and tumors may put pressure on surrounding blood vessels or the trigeminal nerve directly.
- Aneurysms : Aneurysms: A blockage or protrusion in a blood vessel's wall is known as an aneurysm & can put pressure on the trigeminal nerve.
- Virus : Trigeminal neuralgia is also caused by viral infections like chicken pox, shingles, and herpes.
- Trauma : Trigeminal neuropathic facial pain can occasionally be caused by facial trauma, stroke, or ear, nose, or throat surgery.
Risk Factors
The risk factors often involve:
- Gender : Women are more frequently affected by trigeminal neuralgia than men.
- Age : Trigeminal neuralgia is a condition that's become highly prevalent as people grow older.
- High blood pressure : High blood pressure: Trigeminal neuralgia often occurs in patients with high blood pressure.
- Family History : If this TN runs in the family, your chances of getting it are higher than others.
Complications
Treatments for trigeminal neuralgia can occasionally result in problems, including as
- Bleeding or Facial Bruising : This is often a temporary side effect.
- Limited Pain Relief : The procedure provides pain relief from a few months to years. Unfortunately, these procedures sometimes fail to reduce discomfort.
- Numbness : The face may experience partial or total numbness.
- Problems Moving The Facial Muscles : Surgery or other procedures might alter facial muscles' ability to move.
Prevention
Trigeminal neuralgia cannot currently be prevented by following specific rules. By keeping track of possible triggers and avoiding them, patients who now have the condition may be able to prevent attacks and pain.
Diagnosis
A neurologist can diagnose trigeminal neuralgia. In addition to examining the symptoms and performing a comprehensive physical and neurological exam, your doctor will gather a complete medical history. During the neurological examination, the doctor will explore different parts of the face to pinpoint the source of the pain. The reflexes will be examined by the doctor to check if you have a compressed nerve.
The following tests may also be used to identify trigeminal neuralgia:
- Neurological examination : Touching the parts of the face can help the doctor see which branches of the trigeminal nerve may be affected and causing the pain. A reflex test can identify a compressed nerve or another condition that causes symptoms. A proper diagnosis is essential as several illnesses can result in face discomfort. To rule out other conditions, the doctor could request more testing.
- Magnetic resonance imaging (MRI): : Magnetic resonance imaging (MRI): In this exam, skull images are generated using a strong magnet and radio waves. This can help the doctor determine if trigeminal neuralgia is caused by a blood vessel, MS, or a tumor pushing the trigeminal nerve.
Treatment
The doctor may recommend the following approaches:
- Medication
- Surgery While medicine works to treat TN in the majority of instances, sometimes the medication stops working, and the severe sensations might come back. There are various situations when surgery could be a possibility. The most common surgical procedures for TN are
- RhizotomyA rhizotomy involves damaging the nerves to prevent the transmission of pain signals. There are several types of the rhizotomy, including
- Radiofrequency thermal lesioning :
- Balloon compression : A doctor performs this procedure by inserting a needle into the trigeminal nerve via the cheek. They then use a catheter to insert a balloon into the nerve and inflate it near the pain-causing nerve fibers. The balloon compresses the nerve and destroys the pain-producing nerve fibers. After that, the doctor deflates the balloon.
- Glycerol injection : In percutaneous rhizotomy, the doctor injects glycerol to destroy the nerve, dividing it into three sections.
- Stereotactic radiosurgery : The trigeminal nerve's root is exposed to an ionizing radiation dosage during stereotactic radiosurgery using a gamma knife. The transmission of pain is disrupted over time when a lesion forms on the nerve.
- Microvascular decompression (MVD) : This procedure aims to locate a blood artery that may pressure the trigeminal nerve. It is the most invasive operation for trigeminal neuralgia and requires general anesthesia. It carries a low risk of hearing loss, stroke, and facial numbness.
Numbness of the face is a side effect of all rhizotomy types, and the damaged nerve may also heal over time. - Neurectomy : To relieve pain, a neurectomy removes a portion of the trigeminal nerve. Doctors sometimes perform this if a blood artery pushing on the nerve during MVD cannot be found. A part of the face will feel numb for a very long time after this treatment.
- Other Options : Other surgical alternatives include severing the nerve or relocating blood vessels putting pressure on the nerve. All surgical procedure carries the chance of causing temporary to permanent facial numbness. In some circumstances, pain could eventually come back. Your doctor will work with you to choose the best treatment plan after evaluating your symptoms, medical history, and personal preferences.
Medications can ease discomfort and decrease the frequency of attacks. Usually, anti-seizure medications which stop nerve firing are the primary line of treatment, and Tricyclic antidepressants and muscle relaxants are some other second-line or adjunctive medications.
Radiofrequency thermal lesioning involves using heat to burn a section of the pain-causing nerve. The surgeon inserts a hollow needle through the cheek into the nerve; a heating current transmitted by electrodes eliminates the nerve fibers.
Dos and Don’ts
If you or a loved one have TN, you know how difficult it may be for people to comprehend this chronic pain disease. As a result, you could occasionally experience feelings of loneliness and feel overwhelmed. Despite a TN diagnosis, taking care of your mental health, making friends, and practicing self-care may all significantly improve your quality of life. The following methods for trigeminal neuralgia management may help you live a little bit more comfortably along with medical interventions and treatments:
| Do’s | Don’ts |
| Use cold or hot fomentation to relax the facial muscles | Get exposed to triggering factors like extreme hot or cold climatic conditions |
| Keep your mental health in check | Sleep or put a strain on the affected side |
| Cover your face in cold and hot climatic conditions | Use artificial sweeteners in your diet |
| Take your prescribed medications without fail | Consume foods containing gluten |
| Eat food that is soft and easy to chew | Skip meals to avoid pain |
Care at Medicover Hospitals
At Medicover hospital, the best neurologists and medical experts treat patients with trigeminal neuralgia. Our highly skilled team of neurologists uses the most advanced diagnostic instruments, medical equipment, and technology to treat a wide range of neurological disorders. We adopt a multidisciplinary approach to treat trigeminal neuralgia to provide patients with comprehensive care and address their medical needs for a quicker and longer-lasting recovery.
