Trigeminal NeuralgiaTrigeminal neuralgia causes facial pain. Trigeminal neuralgia develops in mid to late life. The condition is the most frequently occurring of all the nerve pain disorders. The pain, which comes and goes, feels like bursts of sharp, stabbing, electric-shocks. This pain can last from a few seconds to a few minutes.
People with trigeminal neuralgia become plagued by intermittent severe pain that interferes with common daily activities such as eating and sleep. They live in fear of unpredictable painful attacks, which leads to sleep deprivation and undereating. The condition can lead to irritability, severe anticipatory anxiety and depression, and life-threatening malnutrition. Suicidal depression is not uncommon.
People often call trigeminal neuralgia "tic douloureux" because of a characteristic muscle spasm that accompanies the pain.
- The pain comes from one or more branches of the trigeminal nerve-the major carrier of sensory information from the face to the brain.
- There are 3 branches of the trigeminal nerve: the ophthalmic, maxillary, and mandibular. The pain of trigeminal neuralgia occurs almost exclusively in the maxillary and mandibular divisions.
- You most commonly feel pain in the maxillary nerve, which runs along your cheekbone, most of your nose, upper lip, and upper teeth. Next most commonly affected is the mandibular nerve, affecting your lower cheek, lower lip, and jaw.
- In almost all cases (97%), pain will be restricted to one side of your face.
- Most of the time, doctors cannot identify any disease of the trigeminal nerve or the central nervous system.
- Trigeminal neuralgia most frequently affects women older than 50 years. The disease occurs rarely in those younger than 30 years. Such cases are usually linked to damage from diseases of central nervous system, for example, multiple sclerosis.
What Causes Trigeminal Neuralgia?
The presumed cause of TN is a blood vessel pressing on the trigeminal nerve as it exits the brainstem. This compression causes the wearing away of the protective coating around the nerve (the myelin sheath). TN may be part of the normal aging process—as blood vessels lengthen they can come to rest and pulsate against a nerve. TN symptoms can also occur in people with multiple sclerosis, a disease caused by the deterioration of myelin throughout the body, or may be caused by damage to the myelin sheath by compression from a tumor. This deterioration causes the nerve to send abnormal signals to the brain. In some cases the cause is unknown.
Trigeminal Neuralgia Symptoms
- A defining feature of trigeminal neuralgia is the trigger zone-a small area in the central part of the face, usually on a cheek, nose, or lip, that, when stimulated, triggers a typical burst of pain.
- A light touch or vibration is the most effective trigger.
- Because of this, many common daily activities trigger the attacks.
- Washing your face, brushing your teeth, shaving, or talking
- Common sensations such as having wind hit your face
- Eating and chewing
- Many people avoid food and drink rather than experience the severe pain.
- These people risk weight loss and dehydration, a leading cause of hospitalization in this group.
- People frequently require hospitalization for rapid pain control when their trigeminal neuralgia becomes unmanageable at home.
- Between attacks, most people remain relatively pain-free. A subgroup, however, experience a dull ache between attacks, suggesting physical compression of the affected nerve, either by a blood vessel or some other structure.
Medical TreatmentTrigeminal neuralgia is extremely painful but not life threatening. Thus, a goal of therapy is minimizing dangerous side effects.
Medications used to treat trigeminal neuralgia are those used for many other nerve pain syndromes-drugs originally designed to treat seizures.
These antiseizure agents suppress excessive nerve tissue activity, which is the cause of the painful syndrome. As a result, they are useful in conditions such as trigeminal neuralgia.
Pain specialists use invasive therapy, including nerve blocks, nerve destruction, and nerve decompression techniques, as well as drug therapy to treat trigeminal neuralgia.
- In some instances, a single injection, or a series of injections, or perhaps one decompressive procedure, will reduce or eliminate the pain and prevent your need for a long course of drug therapy.
- Injection techniques also can relieve unremitting pain instantly and further confirm the diagnosis.
- Using real-time x-rays, doctors can target the anatomical origin of the nerve deep in your skull.
Then, with a fine needle, they can do one of the following to halt the painful syndrome: -
- Inject that source with anesthetic and steroid.
- Inject that nerve with a drug used to destroy faulty cells.
- This procedure can be performed with surprisingly little discomfort.
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