If you experience trigeminal nerve pain as a result of trigeminal neuralgia, finding an effective treatment can be a challenge. When you work with an experienced neurologist and neurosurgeon, they can help take most of the guesswork out of the equation, guiding you to effective solutions for your trigeminal nerve pain.
What Is the Trigeminal Nerve?
The trigeminal nerve is the fifth of twelve cranial nerves that control sensation and muscle function in your face. The trigeminal nerve is responsible for the sensation you feel in parts of your cheeks, chin, forehead and around your eyes.
What Causes Trigeminal Nerve Pain?
The exact reasons some types of trigeminal nerve pain occurs aren’t completely understood. In the majority of cases, it is caused by one of two things – either damage or trauma to the trigeminal nerve (often as a result of an accident) or due to compression of the nerve from a blood vessel (for instance, an artery or nerve) that runs alongside it. In some instances, the cause is completely unknown. This is called idiopathic trigeminal nerve pain.
What Are the Symptoms of Trigeminal Nerve Pain?
Everyone who suffers from trigeminal nerve pain will experience it differently. There are, however, some symptoms that are common to different forms of trigeminal nerve pain. The most common symptoms are stabbing or shock-like bouts of pain, lasting a few moments to minutes. They can occur nearly back to back or every few minutes or even hours. These sensations are usually limited to one side of the face. In what is known as atypical trigeminal neuralgia, the pain is less sharp and tends to be more of a constant and dull, aching pain. These episodes can be brought on by simple acts such as brushing your teeth or lightly touching the side of your face; they can also occur spontaneously, with no trigger.
There are several options for trigeminal nerve pain that can provide relief. Some are more effective and long-lasting than others.
Medication
If you are diagnosed with trigeminal nerve pain, your doctor will likely want to start you on a course of special medications that target the nerves. These include the two most effective and widely used, Tegretol and Trileptal. The use of these anticonvulsants has shown to be effective in some individuals for controlling the errant nerve impulses that can lead to trigeminal nerve pain. Unfortunately, they tend to “wear out,” meaning more and more is needed to control the symptoms until the maximum doses are reached. Other people experience such unpleasant side effects from the medications that they cannot take them.
Drugs such as narcotic painkillers and NSAIDs (non-steroidal anti-inflammatory drugs) have little useful effect on trigeminal neuralgia pain.
Microvascular Decompression
If medication has proven to be ineffective, one possible option is a surgery called microvascular decompression (MVD). This surgery is best suited for you if you are in good health, can withstand general anesthesia and have trigeminal neuralgia that is caused by a vein or artery pressing against the trigeminal nerve. To determine if this is the root cause, a special imaging test called a FIESTA-MRI is often performed.
MVD involves your surgeon creating an opening at the base of your skull and using specialized instruments to access the trigeminal nerve and offending blood vessel. A small Teflon sponge is placed between the two to prevent further contact. Many people experience immediate relief from their trigeminal nerve pain with this surgery.
Gamma Knife Radiosurgery
If MVD surgery isn’t the best option, the next option is often Gamma Knife Radiosurgery (GKRS). This is a relatively non-invasive procedure that is done on an outpatient basis. It takes longer to see results when compared to an MVD, but is ideal for those who cannot withstand anesthesia.
The procedure uses a combination of imaging and finely-focused energy beams to pinpoint the area(s) of your trigeminal nerve that needs to be treated. What makes this a unique and safe treatment is that the radiation used is broken down into about 200 tiny beams. This makes the penetration through tissues practically harmless, but once they reach their focal point, their combined energy delivers a therapeutic dose of radiation to the target area, effectively damaging or killing the offending cells. The vast majority of people who undergo this procedure only require one treatment.
Percutaneous Rhizotomy
Another option that can be considered for trigeminal nerve pain is percutaneous rhizotomy. This is a moderately invasive procedure that uses a long probe that is carefully guided (through your cheek area) into the proximity of the damaged part of your trigeminal nerve. Imaging is used to help guide this probe. Once in place, localized heat is used to destroy the damaged part of the nerve, in essence arresting any misfiring nerve impulses. It can be used in multiple areas on the nerve, allowing for some flexibility in cases with numerous points along the nerve that are causing problems.
Pain Stimulator Placement
Last, but not least, pain stimulator placement may be an option your doctor would recommend. This moderately invasive procedure uses tiny electrodes that are threaded beneath your skin. They are guided to a point or points along your trigeminal nerve. They are then connected to a stimulator, which is a device that creates small electrical pulses. These pulses, when activated, interrupt the misfiring nerve impulses and stop the pain in its tracks.
Other Treatments
The above-mentioned treatments are the most effective and widely used for trigeminal nerve pain. Alternative treatments can be used to complement these.
Yoga and Meditation
Many people find that one or both of these help them to relax. While they will not have a direct impact on your trigeminal nerve pain, they can help curb stress and the body’s reactions to it.
Herbs
At this point in time, there is no herbal remedy that has proven effective for trigeminal nerve pain.
Acupuncture
Acupuncture is found effective in some pain relief studies (such as arthritis) but there are no large-group case studies that have shown it to be effective in every case of trigeminal nerve pain. It can also complement the above treatments. It’s advised that you talk with your doctor before beginning any additional treatments such as acupuncture.
