Trigeminal neuralgia is a rare and debilitating nerve pain disorder. The facial pain associated with trigeminal neuralgia normally only affects one side. With atypical trigeminal neuralgia, pain may still only affect one side, but may also be located on both sides of the face. Trigeminal neuralgia can be exceedingly hard to diagnosis, and so if your doctor comes to this conclusion, it is a very important first step.
Once you’ve been diagnosed, it’s time to learn more about how it may affect you, what medications are typically prescribed, and what surgical interventions you may need to consider.
Understanding Atypical Trigeminal Neuralgia Symptoms
Your trigeminal nerve runs a diagonal line through your face from your temple, past your ear and down to your mouth. Pain at any point along this line is typical for trigeminal neuralgia, but you may experience the pain in multiple ways.
The more common form of trigeminal neuralgia features lightning flashes of pain that are off the pain scale but only last a few seconds at a time. This pain may continue flashing for a while or may be more intermittent.
For atypical trigeminal neuralgia, you’ll likely experience constant pain. Patients always have a high level of pain but may also experience flashes of pain that are significantly worse. The pain may center on your cheek, be closer to your ear or seem like it’s coming from your mouth.
You may be able to examine your lifestyle and habits to determine specific triggers for your atypical trigeminal neuralgia.
For instance, biting into a very cold food or sipping a very cold beverage may set off a flare through your mouth and up across your face. Other patients may experience flares due to cool breezes, after coming into contact with something like a metal utensil in your mouth, or concurrently with a migraine headache or other forms of neuralgia. You may find that you don’t actually have any triggers at all – your trigeminal nerve pain would be considered idiopathic, or without a known trigger or cause.
Diagnosing Atypical Trigeminal Neuralgia
Several different tests may be used to reach your atypical trigeminal neuralgia diagnosis. First, imaging of your head may show compression of the trigeminal nerve by a nearby blood vessel. Second, imaging of other portions of your head can rule out other cranial issues like tumors or MS. And your own records of type and occurrence for your pain is critical information for your doctor to use in reaching your diagnosis.
Medical Management of Atypical Trigeminal Neuralgia
Your first line of treatment after your atypical trigeminal neuralgia diagnosis is prescription medication. Drugs like Trileptal and Tegretol, more commonly used for patients with seizure disorders, can work to disrupt your nerve pain and make living with trigeminal neuralgia far easier.
You may wonder if pain medications may be appropriate as a part of your treatment as well. Unfortunately, many narcotic pain medications won’t really take away the pain of atypical trigeminal neuralgia; they’ll simply mask it for a while. And narcotic pain medications can be habit forming. For this reason, they are rarely prescribed for trigeminal neuralgia patients.
If you do not experience relief after working with your doctor to try different levels of dosage for various medications, or if the side effects of those medications become detrimental, you may need to consider surgical intervention.
Surgery for Atypical Trigeminal Neuralgia
Four different surgical procedures are used in the treatment of trigeminal neuralgia. The four procedures are microvascular decompression, Gamma Knife Radiosurgery, percutaneous rhizotomy and pain stimulator implantation.
If your general health is good and a clear impingement of the trigeminal nerve by a blood vessel can be seen in imaging, the first and likely most effective treatment is microvascular decompression. During this procedure, a small opening will be made at the back of your head in order to expose the trigeminal nerve. Then a surgical sponge will be placed between the nerve and the offending blood vessel, ending the impingement and associated pain.
If you are not a candidate for microvascular decompression, you may next consider Gamma Knife Radiosurgery. During this procedure, multiple beams of radiation target the area of your trigeminal nerve from which your pain is coming, disrupting the signal and lowering or eliminating the pain.
Another procedure to consider is percutaneous rhizotomy. During this type of surgery, a needle will insert a small electrode into your cheek and then pass heat through it to destroy a small portion of the nerve and eliminate pain. This is a multi-step procedure, as you’ll need to be awake during a portion of it to determine what portion of the nerve the heat will target.
A final type of surgery, and typically the last line of defense against trigeminal neuralgia, is the implantation of a pain or nerve stimulator. This very small device and its control pack will be inserted just below your skin. Then a frequency will be directed through the electrode on the pain stimulator, sending alternate signals down the nerve. This confuses the nerve and works to disrupt pain.
Atypical Trigeminal Neuralgia Next Steps
After your atypical trigeminal neuralgia diagnosis, your next step is to continue working with your neurologist and medicinal management of your disorder. Then, if your case must be addressed surgically, you’ll pair with a highly qualified and trained neurosurgeon to ensure you undergo the appropriate treatment to minimize or eliminate your facial pain.
