The pain from trigeminal neuralgia (TN) has been compared to intense electric shocks or violent stabbing sensations. It can be inconveniencing at best; at worst, it’s completely debilitating. If you’re living with the pain and discomfort of TN, it’s time you sought effective treatment to end the cycle.
1. Proper Diagnosis
If you suspect you have trigeminal neuralgia but haven’t received an affirmative diagnosis, you need to start there. A few other conditions can cause extreme facial pain, so it’s important to properly identify whatever is going on so you can receive the right treatment.
Your general practitioner can refer you to a neurologist who specializes in facial pain conditions. You’ll be given a thorough examination and asked questions that help isolate what’s causing your facial pain. This is the first step toward your freedom from pain.
2. Choosing the Right Treatment for You
Assuming you have received a diagnosis for trigeminal neuralgia, the next step is to explore all the treatment options available to you. Your neurologist can help point you in the right direction; sometimes, you need to try a couple of different options before finding the right solution to achieve satisfactory trigeminal neuralgia pain relief.
There are a few tried-and-true treatment protocols for lessening or ridding trigeminal neuralgia sufferers of their pain and discomfort. The first is medication. Your neurologist can develop a drug treatment protocol specifically tailored to your needs and lifestyle. Luckily, a few medications have proven to be effective. If, for some reason, medication doesn’t adequately address the issue, surgical intervention is the next course of action.
Medications
Medication is almost always the first line of defense used against trigeminal neuralgia. Antispasmodics and anticonvulsants have been found to be effective and noninvasive in treating some cases of trigeminal neuralgia. Depending on other medications you may be taking or other conditions you might have, your neurologist will determine which medication(s) will best treat the symptoms you’re experiencing.
Narcotics such as hydrocodone are not recommended for trigeminal neuralgia. They don’t provide any significant level of relief and have the added drawback of potential addiction. Tegretol and Trileptal are the medications of choice; these have been proven to be the most effective for reaching optimum levels of trigeminal neuralgia pain relief. An added benefit of these drugs is that they’re not habit forming.
You may not experience instant relief with medication. It can take time to build to optimum therapeutic levels in your bloodstream. Your doctor should be able to give you a general timeline of when you can expect to see results.
In some instances, medication is not a viable option. This can be due to many reasons, including side effects or breakthrough pain. At this point, nerve block injections or surgical intervention is the next step.
Injections
If drug intervention fails to bring adequate relief, some patients may opt to try botulinum toxin (best known as Botox) injections. Botulinum toxin is injected into the fifth cranial nerve (trigeminal nerve) where it will deaden or interrupt the nerve’s ability to react to stimuli. Some patients find a suitable level of relief from the use of botulinum toxin injections, while others don’t experience any marked relief at all. For those who find relief, botulinum toxin has to be injected every few months to maintain the effects.
Surgery
Surgery is typically only performed after pharmaceutical options have been exhausted or shown to have negative or no impact on a patient. At this point, your neurologist will likely refer you to a neurosurgeon for evaluation and determination of the best surgery for your trigeminal neuralgia. If you decide surgical intervention is the best choice, you have several options.
The first surgery that may be considered is microvascular decompression (MVD). This is one of the most effective surgeries available and doesn’t interfere with nerve function. It’s minimally invasive; your neurosurgeon performs a craniotomy (making a small window in the skull), gaining access to the trigeminal nerve and the blood vessel that is creating the irritation (typically a vein or artery). Once these structures have been identified and isolated, the surgeon places a small insulative sponge between the nerve and blood vessel, essentially creating a cushion between the two so that irritation is minimized or eliminated. Good health and a FIESTA MRI are required prior to having MVD; your neurosurgeon can decide if it’s the right option for you.
For those that can’t or don’t want to undergo MVD, the next best option is Gamma Knife Radiosurgery. This is a noninvasive surgery in which more than 200 beams of radiation focus with pinpoint accuracy on the affected area. A small burst of radiation is applied, with no damage occurring to adjacent tissue. This is typically a one-time procedure, often done on an outpatient basis.
If neither of the above prove to be right for you, your surgeon will probably discuss the possibility of using percutaneous rhizotomy or pain stimulators.
3. The Road to Relief
Once you and your neurologist have decided on a course of action, you can begin to unwind the cycle of pain and frustration that trigeminal neuralgia leaves in its wake.
Regardless of the course of action you choose, seeking treatment to achieve trigeminal neuralgia pain relief should be your main focus. You deserve to live without the excruciating and debilitating pain caused by trigeminal neuralgia.
