Trigeminal neuralgia is a dysfunction of the trigeminal nerve (the fifth cranial nerve in the brain), characterized by severe shooting, burning and stabbing pain in the face. Areas affected include the forehead, eyes, cheeks and jaw. The pain comes and goes in bouts and is usually very bad when it occurs.
What Causes Trigeminal Nerve Dysfunction?
Trigeminal neuralgia can be the result of aging, as most people with the condition are over the age of 50 (although it can happen in younger people).
It can also be caused by demyelination (where the protective covering of the nerves erodes away, leaving them exposed). This leads the nerves to transmit pain signals when there is no reason to feel pain. Around 4 percent of people with trigeminal neuralgia are found to have multiple sclerosis (MS). If you have MS you are at increased risk of having this type of neuralgia.
Other causes include:
Trauma--for instance, a car accident causing injury to the nerves.
Tumors--a tumor may press on the nerves and cause trigeminal neuralgia.
It can also be an after-effect of having shingles.
What Treatments are there for Trigeminal Neuralgia?
The first line treatment is anti-convulants. These shut down the nerves over time and stop the pain. It is thought when the medication is tapered off, the nerves can regenerate normally. Anti-depressants may be used instead for the same effect.
If you have severe side-effects from either of these drugs or if they are contraindicated, there are non-drug options, such as:
• Glycerol injection. This injection is given under sedation. It is given through the cheek. The glycerol kills the nerve endings so they are unable to transmit pain.
• Radiofrequency Rhizotomy – the nerve is heated to kill the nerve endings.
• Cryotherapy – the nerve is frozen.
• Surgery.
If you have the glycerol injection, radiofrquency treatment or cryotherapy, it may leave your face feeling numb afterward. The procedures aren’t life-long and may provide relief for only a few months, but possibly up to a few years. However, they can be repeated if you find the pain is coming back.
Surgery – called microvascular decompression – is when a surgeon makes a small cut behind the ear, inserts an operative microscope and then moves blood vessels away from the trigeminal nerves and places a cushion in between them to stop the problem re-occurring. This is the most effective form of treatment and most patients have immediate relief from pain after their surgery; however, some patient's symptoms re-occur. But overall, 75 percent of patients were still pain-free five years later.
There is a small risk of having a stroke after this surgery, but your neurologist should be able to discuss with you whether you are a suitable candidate for this operation.
Stereotactic radiosurgery is another option. This is where radiation beams are fired directly at the base of the nerve to kill it. If you live in the UK, your access to this treatment may be limited as it is currently only available in three hospitals there.
Emotional Support
Your doctor should refer you for counseling as this type of neuralgia causes severe pain, and since it is usually a long-term condition, it can be very difficult to cope with and many patients suffer depression as a result.
Source: http://www.tna.org.uk/data/files/Pamphlets/trigeminal_neuralgia__an_overview__february_20111.pdf
Joanna is a freelance health writer for The Mother magazine and Suite 101 with a column on infertility, http://infertility.suite101.com/. She is author of the book, 'Breast Milk: A Natural Immunisation,' and co-author of an educational resource on disabled parenting, in addition to running a charity for people damaged by vaccines or medical mistakes.