Trigeminal Neuralgia
What is Trigeminal Neuralgia?
Trigeminal neuralgia is a sharp, shooting, severe pain felt along the path of an irritated or damaged trigeminal nerve, the nerve which carries sensation from your face to your brain.
Trigeminal neuralgia usually occurs when blood vessels press against the trigeminal nerve and this causes irritation and abnormal firing of the nerve. Other causes include multiple sclerosis, a condition which damages the myelin sheath, the protective coating around nerves. It usually affects one side of the face and is most commonly seen in the elderly.
What are the Symptoms of Trigeminal Neuralgia?
Symptoms include sudden attacks of severe, sharp, shooting facial pain that may feel like an electric shock. Certain activities can trigger the pain which includes:
- Brushing your teeth
- Shaving
- Putting on makeup
- Washing or touching your face
- Eating or drinking
- Talking
- A cool breeze on your face
- Vibrations, such as walking or travelling in a car
How is Trigeminal Neuralgia Diagnosed?
When you experience symptoms of trigeminal neuralgia, your doctor will review your history. Your doctor may order an imaging test such as MRI of your head to determine if a tumour or multiple sclerosis is causing trigeminal neuralgia.
What are the Treatment Options for Trigeminal Neuralgia?
Medication:
This the first line and usually involves anticonvulsant medications, analgesics, antidepressants. Over time the effect of the medications might decrease.
Minimally invasive percutaneous ablation of the Trigeminal nerve:
This is done using a needle inserted in the cheek targeting the trigeminal nerve at the base of the skull. It is done under Xray or CT guidance to be precise. Once the needle is at the nerve, heat or pressure is applied to damage the nerve. Patients feel numbness of the face after the procedure. Usually this treatment lasts about 12-18 months before the neuralgia recurs.
Stereotactic Radiosurgery
This is a form of focused radiotherapy that is delivered to the nerve with the aim of damaging it. It takes a few months for the treatment to work and usually the neuralgia recurs after around 18 months. It is non invasive.
Microvascular Decompression of Trigeminal Nerve (MVD)
Surgery might be considered as an option to treat trigeminal neuralgia. The goal of surgery is to relieve the pressure of impeding structures such as blood vessels and tumours. It is the most definitive treatment and has the best cure rate.
