Trigeminal Neuralgia is a chronic pain condition with sudden and severe facial pain. The trigeminal nerve which carries the sensation from our face to the brain gets affected in this condition. It is also known as “tic douloureux”. The pain is usually experienced on one side of the face but very occasionally a person can experience it on both sides. Then the condition is called “bilateral trigeminal neuralgia”.
The initial attacks are usually mild and rare but the condition can worsen into severe and more frequent jolts of searing pain. While this disorder can occur at any age, it mostly affects people above 50 years of age. The sudden and intense bouts of pain is a sign of “classic” trigeminal neuralgia and can be effectively managed by Pain Physician.
The pain caused by trigeminal neuralgia is a result of the compression & disruption of functions of the trigeminal nerve.
Pain in trigeminal neuralgia can feel like coming out of nowhere. Symptoms may include –
Trigeminal neuralgia can be activated by a variety of triggers. Some of these are:
The doctor will diagnose trigeminal neuralgia based on the location, type, severity, and triggers of the pain. Trigeminal neuralgia is mainly a clinical diagnosis.
A neurological examination of your face will enable the doctor to understand the origin of the pain. Reflex tests also help in understanding if the pain is occurring due to a compressed nerve in the face.
Magnetic Resonance Imaging is used to identify tumors or other medical conditions such as multiple sclerosis.
1. Medications: Initial treatment of TN is neuropathic medications like Carbamazepine, Gabapentin, Pregabalin, Valproate. Medication is started at low doses and titrated as per response. Baclofen is a muscle relaxant that is used in the treatment of Trigeminal neuralgia when conventional drugs do not work.
2. When medications cause intolerable side effects or pain is not controlled, interventional pain management options help. This consists of Radiofrequency ablation of Trigeminal nerve branches (ophthalmic/Maxillary/Mandibular). This procedure is done under fluoroscopy or CT guidance. The needle is inserted where Trigeminal ganglion is located in the skull via foramen ovale. The affected branch of the Trigeminal nerve is stimulated to generate pain as experienced by the patient. Once the patient confirms the pain, the nerve is ablated by radiofrequency current. This procedure is safe and gives relief from TN for 2 to 5 years or longer.
3. Surgery: In cases of TN where a tumor is identified, tumor resection surgery needs to be done. In cases where a vascular loop is identified, microvascular decompression surgery is done especially in young patients. In elderly patients with vascular loop, Radiofrequency ablation is preferred over surgery due to the less-invasive nature of this procedure.
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