Trigeminal neuralgia (TN) is a condition characterised by pain, typically on one side of the lower face and jaw, but sometimes affecting area around the nose or above the eye, depending on the branch of trigeminal nerve involved. The type of pain is described as that of an electric shock. It is the most excruciating pain often felt suddenly and lasting only a few seconds to minutes.
Simple daily activities like tooth brushing and shaving the beard can also trigger bouts of intense pain. It is more likely to affect older individuals with women being affected slightly more than men.
So what causes trigeminal neuralgia?
There are two causes of TN – primary and secondary
- Primary TN is caused when one of the branches of TN are irritated or compressed by an artery or a vein. This can cause the trigeminal nerve to misfire and send pain signals to the brain.
- The secondary causes can be due to :
- Compression of trigeminal nerve by a tumor or cyst
- Multiple sclerosis
- Facial trauma.
There are two types of TN:
Typical or type I : The pain felt is sharp, intense and sporadic.
Burning pain is felt all over the face and will last for a few seconds or minutes.
Atypical or type II : This is a less painful form of TN but it can last for a longer period and is widespread.
How is the condition diagnosed?
TN is diagnosed based on your description of the symptoms such as :
The type of pain
Location of the pain
Triggering factors
A physical exam by your doctor will help determine the exact location of the pain which helps determine the branch of trigeminal nerve involved.
An MRI scan may be recommended to help rule out the presence of any tumors or multiple sclerosis.
Treatment:
- The treatment for TN usually starts with medication. People who respond to medication and experience relief in their symptoms require no additional treatments.
The medications include anticonvulsants and anti spasmodic agents.
Other treatments include :
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Glycerol injection :
Your doctor inserts a needle into an opening in the base of the skull, directing the needle into a small sac of spinal fluid surrounding the trigeminal ganglion. The glycerol blocks pain signals sent to the brain thereby relieving symptoms. this method is effective in most of the patients.
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Radiofrequency ablation :
This procedure involves selectively destroying nerve fibres associated with pain. A hollow needle is inserted into the area in the base of the skull where trigeminal nerve passes through. Your doctor inserts an electrode through the needle and sends a mild electric current through the tip of the electrode. You will be asked to notify when you feel a tingling sensation; this is to locate the area of the nerve causing pain. You will be put under sedation and electric current is used to damage the pain causing nerve fibres, creating an area of injury (lesion). additional lesions may need to be created if required.
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Balloon compression :
Your doctor inserts a hollow needle towards the base of the skull. A tube with a balloon at the tip is then inserted through the needle and the balloon is then inflated with enough pressure to damage the trigeminal nerve and block pain signals. This procedure is also effective in most people, atleast for a period of time.
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Neuromodulation :
This includes placement of one or more electrodes in soft tissues at the base of the skull in order to deliver electric stimulation to the part of the brain responsible for pain sensation in the facial area. Neuromodulation patients are often asked to follow up with their specialist every few months following the procedure. During these follow up visits, your doctor may have to adjust stimulation settings and assess your recovery.
Whilst not a fatal condition, TN can affect the quality of life of the sufferer. It is essential that you consult with experienced and compassionate health care providers who can help you in the best possible way.
