Utah Trigeminal Neuralgia Pain & Treatment




What is trigeminal neuralgia?


The trigeminal nerve, also known as the fifth cranial nerve, provides sensory innervation to the face and controls the motor function used for chewing and swallowing. When the trigeminal nerve becomes irritated or inflamed, it is called trigeminal neuralgia (TN). Trigeminal neuralgia is characterized by sudden, usually unilateral, severe, or brief stabbing pains in one or more of the trigeminal nerve branches. It is less often described as a constant, persistent burning and aching sensation. When a patient is suffering from TN, small vibrations or a light touch can trigger a painful episode that lasts anywhere from several seconds to a few minutes. Episodes will likely recur in the following hours or weeks, but then can disappear for months or years before another episode is experienced. Although the pain can be bilateral (both sides of the face), trigeminal neuralgia tends to affect only one side of the face at a time. Women are affected about 50 percent more often than men and roughly 15,000 new cases are diagnosed each year.


Where is the trigeminal nerve and what does it do?


The trigeminal nerve originates in the mid-lateral pons (just above the brain stem) and has three branches that innervate different parts of the face. The first branch is called the ophthalmic nerve (V1). It is responsible for sensation to the scalp, forehead, upper eye lid, nose, frontal sinuses, and the conjuctiva and cornea of the eye. This nerve leaves the skull through the superior orbital fissure. The second nerve is called the maxillary nerve (V2). It is responsible for sensation to the cheek, upper lip, teeth, gums, nasal mucosa, the palate, the maxillary, part of the pharynx, and the ethmoid and sphenoid sinuses. The V2 nerve leaves the skull through the foramen rotundum. The third branch of the trigeminal nerve is called the mandibular nerve (V3). The V3 nerve is responsible for sensations in the lower lip, teeth, gums, chin, jaw, parts of the inner ear, and the floor of the mouth. The V3 nerve exits the skull through the foramen ovale and is responsible for motor function.


What causes trigeminal neuralgia?


Trigeminal neuralgia is usually the result of the compression of the trigeminal nerve. It is often an abnormal loop of intercranial artery or vein that compresses the nerve root near the brain stem. There are also less common causes of compression that lead to trigeminal neuralgia, including tumors, epidermoid cysts, or an aneurysm. The compression causes damage to the myelin, which is the protective covering of the nerve roots. With nerve roots exposed, the nerve acts irregularly and can send pain signals with minor triggers, such as brushing of the teeth or exposure to light. Multiple sclerosis can also damage myelin and cause trigeminal neuralgia.


Diagnosis


Trigeminal neuralgia should be diagnosed by a physician. This diagnosis is based on several factors:

<!--[if !supportLists]-->·      <!--[endif]-->The patient has paroxysmal attacks of pain lasting from less than a second to 2 minutes and is affected in one or more of the branches of the trigeminal nerve

<!--[if !supportLists]-->·      <!--[endif]-->The pain experienced matches one or more of the following descriptions: intense, sharp, superficial, or stabbing

<!--[if !supportLists]-->·      <!--[endif]-->The pain is precipitated by trigger factors or in trigger areas

<!--[if !supportLists]-->·      <!--[endif]-->Attacks are stereotyped in the individual patient

<!--[if !supportLists]-->·      <!--[endif]-->There is no clinically evident neurological deficit

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<!--[if !supportLists]-->·      <!--[endif]-->The pain is not attributed to another disorder

Before a doctor makes a final diagnosis, it is possible that he will want to order radiological imaging in order to get a better picture of the affected area. A doctor might find that facial pain stems from something other than trigeminal neuralgia, such as postherpetic pain or migraine pain.


Utah Trigeminal Neuralgia Treatment


Treating facial pain is considered difficult in the medical field. The first step in treatment is often medication. Some of the medications that a doctor might prescribe are anti-inflammatory, anticonvulsant, and antidepressants. Carbamazepine, an anticonvulsant, is the most common medication used to treat trigeminal neuralgia. If it is ineffective or not well tolerated, it can be combined with Gabapentin, Phenytion, Topiramate, Lamotrigine, or Tizanidine, which is often beneficial. 

If medication fails to provide relief, either an injection or peripheral nerve stimulation will likely be the next step in recovery. If injections and stimulation also fail, it is time to consider a surgical procedure. 

There are a number of surgeries that can be effective and options should be discussed with a pain specialist. Some potential surgeries include: 

<!--[if !supportLists]-->·      <!--[endif]-->Electrolytic rhizotomy- a procedure that creates a lesion in the ganglion of the trigeminal nerve using radio frequency

<!--[if !supportLists]-->·      <!--[endif]-->Balloon compression- involves a balloon being inflated to compress the gasserian ganglion

<!--[if !supportLists]-->·      <!--[endif]-->Chemical rhizotomy- glycerol is injected into the trigeminal cistern

<!--[if !supportLists]-->·      <!--[endif]-->Microvascular decompression- the removal or separation of vasculature from the trigeminal nerve

<!--[if !supportLists]-->·      <!--[endif]-->Gamma knife radiosurgery- uses gamma radiation to create a lesion near the proximal trigeminal root

<!--[if !supportLists]-->·      <!--[endif]-->Linear accelerator radio surgery- gamma knife radiosurgery but uses linear acceleration, a different kind of radiation

 

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