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Trigeminal neuralgia, thought of as one of the most excruciating pain one could ever experience, and also known as tic douloureux, affects the trigeminal nerve in the head. The pain is characterized by an intense, searing, stabbing and electric shock-like sensation caused by an irritation or damage to the trigeminal nerve. The pain is usually felt in the skin of the lower face and jaw, although it can extend to areas around the nose and above the eye. If one has trigeminal neuralgia, even mild stimulation of one’s face – such as from brushing one’s teeth or talking – may trigger a jolt of unbearable pain.
Developing trigeminal neuralgia doesn’t ultimately condemn one to a life of pain as a variety of treatment options are available. Doctors can usually manage trigeminal neuralgia effectively with medications, injections or surgery.
Approximately, 14,000 people develop trigeminal neuralgia in the United States annually, and 140,000 people currently live with the condition. It is estimated to affect about one million people worldwide.
A common risk factor for trigeminal neuralgia is age. The condition is usually rare before the age of 50. Multiple sclerosis (MS) is another predisposing factor, as tic douloureux sometimes can occur in young adults who have MS. In patients with multiple sclerosis, damage to the myelin sheath (a fatty substance) that surrounds and insulates nerve fibers in the trigeminal nerve can cause hardening (sclerosis) of the nerve fibers and result in trigeminal neuralgia. Women are twice as likely to develop trigeminal neuralgia as men.
For trigeminal neuralgia, it is all about the debilitating pain. So, most symptoms of the condition are accompanied by pain. Trigeminal neuralgia symptoms may include one or a combination of the following patterns:
In severe cases, these attacks of pain may occur several (about a hundred) times each day. Some patients may experience no symptoms for months or years between attacks. Some patients will have specific points on their face, that if when touched, pain will be triggered.
A doctor will generally make their diagnosis for trigeminal neuralgia by carrying out a physical examination, reviewing medical history, and conducting specific diagnostic tests. These are carried out to check if the trigeminal nerve is involved and to look for underlying causes of the condition. This is because many other conditions have symptoms similar to trigeminal neuralgia, therefore the need for accurate diagnosis.
Physical examination is based on the description of the pain provided by the patient. These descriptions are classified according to the type of pain (pain associated with trigeminal neuralgia is sudden, electric shock-like, and transient), location (areas of the face affected will indicate the involvement of the trigeminal nerve) and triggers (stimulation of the cheeks by chewing, talking, or even encountering a cool breeze will usually trigger trigeminal neuralgia- related pain).
Medical history review of the patient is also important as it provides vital information other than the symptoms of the condition, enabling a doctor to identify other possible conditions or factors that may be causing pain. This information includes current medications, previous diagnosis, and/or past treatments.
Specific diagnostic tests carried out may be neurological tests or advanced diagnostic tests. An example of a neurological test for diagnosing trigeminal neuralgia is trigeminal reflex testing and this is carried out to examine the facial sensitivity using certain materials and to analyze the sensory responses. Reflex tests like this can help a doctor determine whether the symptoms are caused by a compressed nerve or another condition.
The common types of advanced diagnostic tests for diagnosing trigeminal neuralgia include medical imaging tests, such as Magnetic resonance angiography (MRA) and Magnetic resonance imaging (MRI).
Magnetic resonance angiography is a method used to diagnose trigeminal neuralgia caused by blood vessel compression. This method employs the use of a dye injected into the blood vessel to highlight the blood flow. This method clearly defines the presence and severity of compressions caused by blood vessels on nerves, consequently making it a very effective way for diagnosing trigeminal neuralgia.
Magnetic resonance imaging provides a clear picture of soft tissues, such as the brain, spinal cord, and nerves. This makes it possible to assess nerve integrity and to determine whether trigeminal neuralgia is as a result of multiple sclerosis or tumors.
Advanced diagnostic methods may prove abortive in determining the cause of idiopathic trigeminal neuralgia.
There are a number of other conditions that can mimic the symptoms of trigeminal neuralgia. So, differential diagnosis is necessary in order to be able to accurately diagnose the condition. Some of these conditions are nerve pains such as glossopharyngeal neuralgia, occipital neuralgia. Inflammatory conditions such as dental pain, giant cell arteritis, middle ear infections and sinus infections can also produce similar symptoms as trigeminal neuralgia.
It is very important for the doctor to get an accurate diagnosis as it will ensure that a suitable treatment plan is developed for pain relief.
Medications are the first go-to treatment for trigeminal neuralgia, and for some people, they suffice. Nevertheless, after some time, some people with the condition may relapse, and will consequently need other treatment methods such as injections or surgeries due to either adverse side effects or ineffectiveness of medications from prolonged use.
In treating trigeminal neuralgia, your doctor will prescribe medications that block or reduce the pain signals transmitted to the brain. Such medications include anticonvulsants. A commonly prescribed anticonvulsant is carbamazepine (Tegretol, Carbatrol, others). If the anticonvulsant you are using starts becoming ineffective, your doctor may increase dosage or simply switch to another type. Other medication treatments include antispasmodic agents and botox injections.
Trigeminal neuralgia can be surgically treated in two common ways. These are microvascular decompression and brain stereotactic radiosurgery (Gamma knife). In microvascular decompression, the blood vessels are removed or relocated elsewhere to stop them interfering with nerve, preventing nerve malfunction. During the surgery, a soft cushion is placed between the arteries interfering with the trigeminal nerve. This stops the arteries from compressing the nerve, consequently preventing irritation or damage and therefore, eliminating or reducing the pain.
In brain stereotactic radiosurgery, a laser of radiation is directed at the root of the trigeminal nerve by the surgeon. This damages the trigeminal nerve, consequently eliminating or reducing the pain.
Rhizotomy is another procedure used to treat trigeminal neuralgia. Here, the surgeon destroys the nerve fibers to ease pain. Some facial numbness may result. Types of rhizotomy include glycerol injection, balloon compression and radiofrequency thermal lesioning.
Other treatment methods
There are other treatment methods, but these methods have not been adequately studied as well as the other treatment options i.e. medications or injection and surgery. Such treatments include acupuncture, chiropractic, biofeedback, vitamin and nutritional therapy.
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