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Trigeminal neuralgia is a condition that causes painful sensations similar to an electric shock on one side of the face. This chronic pain condition affects the trigeminal nerve, which carries sensation from your face to your brain. If you have trigeminal neuralgia, even mild stimulation of your face — such as from brushing your teeth or putting on makeup — may trigger a jolt of excruciating pain.
You may initially experience short, mild attacks. But trigeminal neuralgia can progress and cause longer, more-frequent bouts of searing pain. Trigeminal neuralgia affects women more often than men, and it’s more likely to occur in people who are older than 50.
Because of the variety of treatment options available, having trigeminal neuralgia doesn’t necessarily mean that you’re doomed to a life of pain. Doctors usually can effectively manage trigeminal neuralgia with medications, injections or surgery.
In trigeminal neuralgia, also called tic douloureux, the trigeminal nerve’s function is disrupted. Usually, the problem is contact between a normal blood vessel — in this case, an artery or a vein — and the trigeminal nerve at the base of your brain. This contact puts pressure on the nerve and causes it to malfunction.
While compression by a blood vessel is one of the more common causes of trigeminal neuralgia, there are many other potential causes as well. Some may be related to multiple sclerosis or a similar disorder that damages the myelin sheath protecting certain nerves. Trigeminal neuralgia can also be caused by a tumor compressing the trigeminal nerve.
Some people may experience trigeminal neuralgia due to a brain lesion or other abnormalities. In other cases, surgical injuries, stroke or facial trauma may be responsible for trigeminal neuralgia.
Trigeminal neuralgia symptoms may include one or more of these patterns:
- Episodes of severe, shooting or jabbing pain that may feel like an electric shock
- Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking or brushing teeth
- Attacks of pain lasting from a few seconds to several minutes
- Pain that occurs with facial spasms
- Bouts of multiple attacks lasting days, weeks, months or longer — some people have periods when they experience no pain
- Pain in areas supplied by the trigeminal nerve, including the cheek, jaw, teeth, gums, lips, or less often the eye and forehead
- Pain affecting one side of the face at a time
- Pain focused in one spot or spread in a wider pattern
- Pain rarely occurring at night while sleeping
- Attacks that become more frequent and intense over time
To treat trigeminal neuralgia, your doctor usually will prescribe medications to lessen or block the pain signals sent to your brain.
Anticonvulsants. Doctors usually prescribe carbamazepine (Tegretol, Carbatrol, others) for trigeminal neuralgia, and it’s been shown to be effective in treating the condition. Other anticonvulsant drugs that may be used to treat trigeminal neuralgia include oxcarbazepine (Trileptal, Oxtellar XR), lamotrigine (Lamictal), valproate and phenytoin (Dilantin, Phenytek, Cerebyx). Other drugs, including clonazepam (Klonopin), topiramate (Qsymia, Topamax, others), pregabalin (Lyrica) and gabapentin (Neurontin, Gralise, Horizant), also may be used.
If the anticonvulsant you’re using begins to lose effectiveness, your doctor may increase the dose or switch to another type. Side effects of anticonvulsants may include dizziness, confusion, drowsiness and nausea. Also, carbamazepine can trigger a serious drug reaction in some people, mainly those of Asian descent, so genetic testing may be recommended before you start carbamazepine.
- Antispasmodic agents. Muscle-relaxing agents such as baclofen (Gablofen, Lioresal, Ozobax) may be used alone or in combination with carbamazepine. Side effects may include confusion, nausea and drowsiness.
- Botox injections. Small studies have shown that onabotulinumtoxinA (Botox) injections may reduce pain from trigeminal neuralgia in people who are no longer helped by medications. However, more research needs to be done before this treatment is widely used for this condition.
Microvascular decompression. This procedure involves relocating or removing blood vessels that are in contact with the trigeminal root to stop the nerve from malfunctioning. During microvascular decompression, your doctor makes an incision behind the ear on the side of your pain. Then, through a small hole in your skull, your surgeon moves any arteries that are in contact with the trigeminal nerve away from the nerve, and places a soft cushion between the nerve and the arteries.
If a vein is compressing the nerve, your surgeon may remove it. Doctors may also cut part of the trigeminal nerve (neurectomy) during this procedure if arteries aren’t pressing on the nerve.
Microvascular decompression can successfully eliminate or reduce pain for many years, but pain can recur by 10 years in three out of 10 people. Microvascular decompression has some risks, including decreased hearing, facial weakness, facial numbness, a stroke or other complications. Most people who have this procedure have no facial numbness afterward.
Brain stereotactic radiosurgery (Gamma knife). In this procedure, a surgeon directs a focused dose of radiation to the root of your trigeminal nerve. This procedure uses radiation to damage the trigeminal nerve and reduce or eliminate pain. Relief occurs gradually and may take up to a month.
Brain stereotactic radiosurgery is successful in eliminating pain for the majority of people. However, like all procedures, there is a risk of recurrence, often within 3 to 5 years. If pain recurs, the procedure can be repeated or an alternative procedure can be performed. Facial numbness is a common side effect, and may occur months or years after the procedure.
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