Trigeminal neuralgia is a painful condition that can rob you of your normal, active lifestyle. Understanding why your symptoms are occurring is the first step toward being able to choose the best trigeminal pain management solutions. Your doctor can guide you through this process, helping you explore each option.
What Is Trigeminal Neuralgia?
Trigeminal neuralgia (sometimes referred to as TGN) is a condition in which the trigeminal nerve malfunctions, creating unbearable pain symptoms. It is caused by either an injury, trauma or degeneration of the nerve’s myelin (the protective layer that encases the nerve). It can also be caused by the compression of the nerve from a nearby blood vessel, such as an artery.
The classic symptom of TGN is shock-like episodes of pain on one side of the face. It can be brought about by something as simple and routine as brushing your teeth, or even a cool breeze moving over your face. Atypical trigeminal neuralgia has slightly different symptoms, usually manifesting as an aching, burning sensation that lasts for an extended period of time, rather than fleeting bouts, such as are experienced with classic trigeminal neuralgia.
Getting a Diagnosis
Receiving a proper diagnosis is the most important step in being able to develop an effective trigeminal neuralgia pain management plan. Often times, dental issues are thought to be the culprit. Many people will undergo unnecessary dental treatments in pursuit of relief, only to find that they are ineffective. This is one of the main reasons it’s important to get an accurate diagnosis – ruling out other causes will allow you to seek the appropriate treatment.
If you suspect you may be suffering from trigeminal neuralgia, make an appointment with your general practitioner. He or she can perform routine tests such as a physical exam and a basic neurological exam. You may then be referred to a neurologist for further assessment. If it’s determined you have trigeminal neuralgia, your doctor or neurologist may recommend a consultation with a neurosurgeon.
Medication for Trigeminal Neuralgia
Most doctors will initially try you on a course of medications to see if your trigeminal neuralgia symptoms will respond to this type of intervention. Two particular medications from the anticonvulsant family – Tegretol and Trileptal – have proven to be effective in managing some of the trigeminal neuralgia pain symptoms.
However, the main drawback to using these medications are the side effects. Some people experience dizziness, nausea, headaches and a feeling of intoxication when using these drugs that make them a non-viable option. Many people also find that they eventually reach the highest allowable and safe doses and are no longer getting the relief they need to function normally. If this is the case with you, you will need to seek out a different means of trigeminal neuralgia pain management.
Microvascular Decompression
One of the most successful treatments for trigeminal neuralgia is a surgical procedure known as microvascular decompression (MVD). While it is not for everyone, if you are in good health and can withstand anesthesia, you may be a good candidate. There is one caveat to MVD: it will only be an effective treatment if your trigeminal neuralgia is being caused by nerve compression from a blood vessel. To determine if this is the root cause of your TGN, you will be referred for an imaging test known as a FIESTA-MRI. This non-invasive, specialized test allows doctors to see your nerves and blood vessels and determine if they are too close together, causing compression. If they are, you will likely be referred for microvascular decompression. There is a very good success rate with this surgery, with around 90 percent of patients experiencing complete relief following the procedure.
Gamma Knife Radiosurgery
For patients who are experiencing trigeminal neuralgia symptoms that are not due to compression, Gamma Knife Radiosurgery (GKRS) may be the perfect option. It is also ideal if you are unable to withstand anesthesia or would prefer to pursue non-invasive treatments. Gamma Knife Radiosurgery is not surgery at all but rather the use of approximately 200 tiny beams of radiation. Each of these beams on their own is basically nothing more than a slightly concentrated energy. This allows it to pass through tissues without causing damage. However, when all of these beams are focused on a target, their combined energy upon reaching it creates a therapeutic dose of radiation that damages the cells in just that tiny spot, much like in standard radiation. GKRS is done on an outpatient basis and typically only requires one treatment to gain results.
Percutaneous Rhizotomy
Percutaneous rhizotomy is another option for those with trigeminal neuralgia who can’t or don’t wish to undergo surgery. This procedure uses a special needle-like instrument. It is inserted through your cheek (you will be sedated for this aspect to maintain your comfort, with local anesthetic as the insertion point) and guided to the trigeminal nerve. This same instrument then delivers focalized heat to slightly damage your trigeminal nerve, effectively stopping the painful nerve impulses from traveling to your face.
Pain Stimulator Placement
Last but not least, pain stimulator placement is an additional treatment you can explore. This procedure involves threading one or more tiny electrodes under your skin and to or near your trigeminal nerve. Once in place, these electrodes are hooked up to a stimulator. When a pain episode starts the stimulator sends out a mild energy current that disrupts the painful impulse and prevents it from traveling along the nerve. Initially, you will have an external stimulator but once the trial period is over (during which it will be determined if this is an effective pain relief method for you), a permanent stimulator will be installed under your skin.
More options than ever are now available for trigeminal neuralgia pain management. Working with your doctor, you can explore the possibilities and decide on a solution that will work best for you and your lifestyle.
