If you suffer from bilateral trigeminal neuralgia, you probably feel a sense of desperation to find relief, whether it be from medications, a procedure or surgery. Understanding the causes of the pain and the treatment options available helps you make the best decision when choosing a physician and your plan of care.
What is Trigeminal Neuralgia?
Trigeminal neuralgia is a condition that causes extreme facial pain. Typically, it is on one side of the face, but with bilateral trigeminal neuralgia, the pain affects both sides of the face. This medical problem is more common in women, but it also affects men. The pain is a sudden, shock-like effect; some sufferers compare it to the severe pain of childbirth, a kidney stone or a heart attack. The pain often lasts only a few seconds, but it can be repetitive in nature.
What Causes This Problem?
Blood vessels travel alongside your nerves. When they are inflamed or irritated, they can press on the nerve, and this results in pain. A dental procedure, medical problem or other type of trauma can cause the irritation, although sometimes the cause is unknown. The simplest motion can cause the pain to occur, such as brushing your teeth, water splashing on your face from the shower, someone caressing your face, a gentle breeze, shaving or simply nothing at all. Although the condition can appear for a time and then disappear for weeks or longer, the fear of it returning with a vengeance is sometimes terrifying.
Taking Action
It is important to see a neurologist to diagnose your condition. It is wise to be quite detailed in explaining your history with this medical problem. Take notes when you suffer from an attack. Note down what seems to trigger the pain, and what seems to make it better or worse.
The neurologist will do lab work and a CT scan or MRI to rule out other diseases, such as multiple sclerosis. The only definitive way to correctly diagnose the disease is to succinctly describe the extent of the pain, how often it occurs and a detailed history of the problem.
Types of Treatment
It is important to know that there are many treatments for this condition and that what works well for one person may not work at all for another patient. Typically, the first course of action is to treat the problem with medications. Many of these medications are the kind that treat seizures as well, such as Gabapentin or Carbamazepine. These medications often work long term in treating the pain of someone who suffers from bilateral trigeminal neuralgia.
If medications have little or no effect on you, the neurologist may suggest that you see a board-certified neurosurgeon to discuss other options. These include microvascular decompression, Gamma Knife Radiosurgery, percutaneous rhizotomy or placement of a pain stimulator.
Microvascular Decompression
Another minimally invasive surgery that helps many sufferers of bilateral trigeminal neuralgia is microvascular decompression. The doctor makes a tiny incision behind the patient’s ear and inserts a small ‘pillow’ to separate the nerve and the blood vessel that is irritating the nerve. This device is made of a non-sticky material called PTFE. Generally, the patient is released from the hospital within one or two days and feels instant relief from the pain.
Gamma Knife Radiosurgery
During Gamma Knife Radiosurgery, multiples beams of radiation are delivered to the site in order to bring about relief from the bilateral trigeminal neuralgia pain. This procedure only takes one treatment. This option is strongly recommended for elderly patients or those whose poor health or medical history makes it risky to undergo another type of surgery.
Percutaneous Rhizotomy
Percutaneous Rhizotomy is generally an outpatient surgery that is also minimally invasive. The surgeon inserts a needle into your cheek that injects a small balloon. This balloon disrupts the nerve pathways that are causing the pain. Most patients feel immediate relief, but numbness may be a temporary or permanent side effect of the surgery. Most patients feel this is a small price to pay for the pain relief.
Keep in mind that you are not alone. Many people suffer from bilateral trigeminal neuralgia, but there are ways to greatly reduce or completely eliminate the pain. You and your doctor may find that the first treatment option you select results in complete pain relief. Others may find that it is a matter of trial and error before they obtain relief. Discussing the treatment options with your physician helps you both determine the best options for you based on your overall health, age, and medical history.
Pain Stimulator Placement
Using a pain stimulator is often an excellent way to rid some patients of their trigeminal neuralgia pain. The doctor numbs the area and then inserts a tiny electrode under the skin. This directs mild electrical impulses to the trigeminal nerve, which help to reduce or eliminate the pain.
For the first 24 hours, you will be observed in the hospital. After that, you can go home with a temporary pain stimulator. This trial period allows the surgeon and the patient to determine if this treatment plan is right for you. After the initial trial period, if the pain stimulator has been beneficial, a permanent pain stimulator will be implanted in the same manner. This allows you to experience pain relief. 