When something damages the trigeminal nerves, the face/forehead area becomes susceptible to severe pain. Solutions vary from chemically attenuating the pain nerves to repairing the nerve damage through surgery.
There is a nerve bundle called trigeminal nerve. It controls the sensation and movement in our face.
The nerve bundle comes out of the rear side of the brain and divides into three branches. Each branch has two types of nerves. One for sensation and another for movement control (tri = three, geminal = two).
When something like an errant blood vessel, tumor, or an unknown reason damages these nerves, the part of the face supplied by the affected nerve become super-sensitive to pain. Even a light sensation, like washing the face or chewing something can feel like being stabbed.
This pain called by defunct trigeminal nerve is called “Trigeminal Neuralgia”.
In some cases, the pain can appear spontaneously, then vanish without warning, only to come back again after hours, days, weeks or months. This is identified as Type-1 Trigeminal Neuralgia or TN1. In other people, the pain exists as a persistent dull pain. This is called Type-2 Trigeminal Neuralgia or TN2.
People over 60 are more susceptible to it. Similarly, women have higher chances of getting this condition than men. The right of the face has 5 times higher chances of TN pain than the left.
Complication due to Trigeminal Neuralgia
Trigeminal Neuralgia is not a life-threatening disease. But when the pain attacks, patients excruciating and find it unbearable. Most of them can’t focus on day to day life. Some cannot even go to sleep.
Lack of focus, rest and sleep can seriously affect the patient’s quality of life. Also, if the patient is administered a long course of steroidal or pain-relieving medication, they have their own adverse side effects.
Symptoms of Trigeminal Neuralgia
Trigeminal neuralgia is marked by severe, sharp facial pain. Apart from this, patients may also experience:
- Numbness over some areas of the face
- Pins and needles sensation over the face
- Increased facial sensitivity
- Sudden involuntary facial twitches
Trigeminal Neuralgia is primarily diagnosed through clinical observations.
TN pain is seen in the area addressed by the trigeminal nerve. It can occur repeatedly, from fraction of a second to lasting up to 2 minutes.
The pain intense and sharp. It can be superficial or stabbing. It can be spontaneous or triggered by something specific.
Persons affected by trigeminal neuralgia try to protect their face from being touched. If the patient rubs or holds the face to lessen the pain, then it is probably not TN. The source of the pain may well be a toothache.
If there is some weakness in the jaw muscle or the eye doesn’t blink when the white of the eye is touched, then the TN is probably caused by something crushing on the Trigeminal nerve. To find out what is crushing the Trigeminal nerve, the doctor may order an MRI imaging study.
If there is no weakess in the jaw muscle, or the eye does blink when the cornea is touched, then it must be concluded that the source of TN is idiopathic (source unknown).
Treatment for Trigeminal Neuralgia
Based on the nature of the condition, multiple options are available for treating Trigemial Neuralgia.
All patients suffering form Trigeminal Neuralgia end up going on pain relieving drugs. This doesn’t correct the condition. It only treats the symptoms.
- If a patient with multiple sclerosis reports of TN pain, then the MS drug lamotrigine may help them
- If the patient has no known cause for TN, then they usually respond to anticonvulsant drugs.
Patient who don’t respond to medical treatment may be recommended for interventional or surgical treatment.
Several interventional procedures are available for Trigeminal Neuralgia. Of these, Glycerol Rhizotomy is the most promising.
Glycerol Rhizotomy: Glycerol is injected at a particular point on the face. As the trigeminal nerve is bathed in glycerol, it selectively destroys the pain fibres that fire improper signals.
Radio Frequency Ablation: In this procedure, high frequency heat is used to target the traigeminal nerve and thereby the ability of the nerve to transmit pain is destroyed. The procedure is very effective but the pain may re-occur after 2 years.
Balloon Compression: With help of a tiny balloon, the part of the trigeminal nerve that transmits pain signals to the brain, is compressed. As the balloon is inflated, the nerve is compressed. Once the procedure is complete, the balloon is deflated and removed out of the skull. 9 out of 10 patients respond to this treatment procedure. However, recurrence is common.
Cryotherapy: In this procedure, nerve fibers firing improper signals are frozen, and deactivated.
Accupuncture: Placing acupuncture needles at specific points on the face, provides immediate relief from symptoms of neuralgia. This technique is much effective when combined with medical treatment with anticonvulsant drugs.
Two surgical options are available for Trigeminal Neuralgia.
Microvascular Decompression: This is a minimally invasive procedure. It is used when a blood vessel compresses upon the trigeminal nerve. In this technique, using an endoscope, the blood vessel and nerve is simply separated using a teflon patch.
Gamma Knife Radiosurgery: This is a painless minimally invasive procedure that uses precise focused radiation beams to selectively deactivate pain fibers in the trigeminal nerve.
Treatment should be initiated, as soon as the condition is identified, and the diagnosis confirmed. Delayed intervention results in frequent, severe pain attacks that interferes with day-to-day activities.