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Trigeminal Neuralgia

Shooting Facial Pain

Trigeminal neuralgia or “tic douloureux” is some of the worst pain ever.  It is characterized as as an electrical sharp shooting pain across the face following the course of the trigeminal nerve.  It is often initally mistaken for a tooth problem.    The trigeminal nerve has three divisions with the division one being above eye, division two below the eye and in the upper teeth and mid face and division three in the lower jaw.  Divisions two and three are the most frequent locations of the pain.  It rarely affects both sides.  

Trigeminal neuraglia pain is so horrible it become distressing and one works to avoid triggers since the pain is so severe.  Luckily there are 4 methods of treatment. 

 
 
 
 
 
 
 
 
 
 

In trigeminal neuralgia, the nerve’s function is disrupted, typically by a normal blood vessel putting pressure on the nerve.  This contact occures at the site of the trigeminal nerve exiting from the brain stem.  

Trigeminal neuralgia can occur as a result of compression from a tumor or direct myelin sheath disruption as seen in multiple sclerosis.

Triggers

Many otherwise trivial triggers may set off the pain of trigeminal neuralgia, including:

  • Talking or smling
  • Shaving
  • Touching your face or brushing your teeth
  • Eating or drinking 
  • Putting on makeup or washing your face
  • Cold air or wind

Symptoms

Trigeminal neuralgia symptoms may include one or more of the below:

  • Episodes of severe, shooting or jabbing electrical pain 
  • Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking or tooth brushing 
  • Pain episodes usually hit maximum immediately and last from seconds to minutes
  • Groupings of several attacks last days, weeks, months or longer – luckily some people will have periods when they experience no pain
  • Constant aching, burning pain may occur with the more typical symptoms
  • Pain in areas supplied by the trigeminal nerve, including the cheek, jaw, teeth, gums, lips, or less often the eye and forehead
  • Pain usually affects one side of the face at a time, though may rarely affect both sides of the face
  • Pain focused in one spot or wide spread
  • Attacks that become more frequent and intense over time and can convert to atypical facial pain over time

 

When to See a Doctor

If you experience facial pain that is severe or prolonged and/or recurring or unrelieved by common pain relievers.

Treatments

Trigeminal neuralgia is treatable with medications like tegretol, gabapentin or other never modulationg medications. Opioids are not particularly useful.  Three procedures care considered with your doctor. 

Percutaneous Rhizotomy

Performed under sedation or anesthesia the surgeon places a needle under X-ray guidance into the ganglia of the nerve (like an electrical ciruit breaker.  Once in position the treatment of glycerine and or electrical heat distrupts the abnormal firing of the nerve and eliminates pain.  This procedure usually last 6 months to 2 years with some patients having more than 10 years of relief.  The procedure can be repeated.  

Radiosurgery

After computer planing the patient lays still in the radiation sutie for about an hour.  Computer precise beams of radiation target the base of the nerve (entry root zone).   This causes an elimination or improvement of pain.  This procedure usually last months to 2 years with some patients having longer term relief.  The procedure can be repeated only once.  

Microvascular decompression.   

This is the gold standard treatment.  It involves a small incision behind the ear.  Under careful microscopic visualization the surgeon places a teflon padding between the nerve and offending blood vessel.  This will create long term pian relief in up to 85% of patients.  

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