Trigeminal Neuralgia

Introduction

     Trigeminal neuralgia is an extremely painful inflammation of the largest nerve in the skull (trigeminal nerve).

Causes

• Trigeminal neuralgia is due to irritation of the trigeminal nerve, which is one of the nerves of the face.

• Often, there is no apparent cause of this nerve irritation.

• Occasionally, it can be due to diseases such as Multiple Sclerosis, Brain Aneurysm, Brain Tumor, or narrowing of the tunnel through which the trigeminal nerve passes from the brain to the face.

Symptoms

• The typical symptom of trigeminal neuralgia is excruciatingly severe pain that begins suddenly on one side of the face. It usually begins at the mouth and then shoots up toward the eye, ear, or nose on the same side of the face. It is very unusual for the pain to be on both sides of the face.

• The pain comes and goes, usually lasting a few seconds to a few minutes.  As the disease progresses, the painful episodes often become more frequent and severe.

• The patient may be pain free for a few minutes or longer.  However, some develop a continuous dull ache that never goes away.

• Touch, chewing, wind drafts, or facial movements can trigger painful episodes.  In some, there are specific sites on their face that if touched, result in severe pain.

Screening and Diagnostics

• The typical symptoms usually help make the diagnosis.

• If the symptoms are not typical or if the patient does not respond to treatment, tests such as CT scan, MRI scan, nerve testing, spinal tap, or X-Rays may be done to eliminate other causes of the pain.

• Occasionally, a referral to a specialist (such as a neurologist or neurosurgeon) may be needed.

Treatment

• Treatment for this disorder usually starts with medicines. If not effective, surgery may be needed.

• Medicines used to treat this disease include:

1. Carbamazepine -- most commonly used to treat.  It is an anti-seizure medicine that works well to control the pain associated with this disease.  Blood counts and liver tests must be monitored with this medicine.

2. Dilantin -- an anti-seizure medicine that can be tried if Carbamazepine does not work.

3. Baclofen -- a muscle relaxant that can be used alone or with either of the two drugs listed above.

4. Gabapentin -- another anti-seizure medicine used when the above medicines fail.

5. Amitriptyline -- an anti-depressant that frequently offers relief from the pain.