Trigeminal Neuralgia

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Trigeminal neuralgia is a condition characterized by intense pain originating from the trigeminal nerve, a nerve that branches near the top of the ear and extends towards the eye, cheek, and jaw. While we have two trigeminal nerves—one for each side of the face—trigeminal neuralgia typically affects only one side.

The pain associated with trigeminal neuralgia is distinct and extremely severe, setting it apart from other facial pains. Described as stabbing, sharp, or electric, the pain reaches such intensity that individuals affected may find it challenging to eat or drink. The pain swiftly travels across the face within seconds, and as the condition progresses, these episodes can extend to minutes and beyond.

Treatment of Trigeminal Neuralgia

There are several effective ways to alleviate the pain, including a variety of medications. Medications are generally started at low doses and increased gradually based on patient’s response to the drug.

There are drawbacks to medications. Some patients may need relatively high doses to alleviate the pain, and the side effects can become more pronounced at higher doses. Anticonvulsant drugs may lose their effectiveness over time. Some patients may need a higher dose to reduce the pain or a second anticonvulsant, which can lead to adverse drug reactions. Many of these drugs can have a toxic effect on some patients, particularly people with a history of bone marrow suppression and kidney and liver toxicity. These patients must have their blood monitored to ensure their safety.

If medications have proven ineffective in treating TN, several surgical procedures may help control the pain.

Surgical treatment is divided into two categories: 1) open cranial surgery or 2) lesioning procedures. In general, open surgery is performed for patients found to have pressure on the trigeminal nerve from a nearby blood vessel, which can be diagnosed with imaging of the brain, such as a special MRI. This surgery is thought to take away the underlying problem causing the TN. In contrast, lesioning procedures include interventions that injure the trigeminal nerve on purpose, in order to prevent the nerve from delivering pain to the face. The effects of lesioning may be shorter lasting and may result in numbness to the face.