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TRIGEMINAL NEURALGIA

 

Trigeminal neuralgia is an inflammation of the trigeminal nerve which carries sensations from the face to the brain. As a result, there is intense and chronic facial pain, especially on the right side. Trigeminal neuralgia causes severe pain even with simple activities such as brushing teeth or applying makeup, affecting daily life.

The condition begins as mild attacks which last for a short time and progresses to long-lasting, and searing pain which occurs more frequently. Usually, it lasts for a few seconds to minutes or hours. However, uncontrolled trigeminal neuralgia can become chronic but is not life-threatening.

Symptoms

One or more of the following symptoms are exhibited by the patients with trigeminal neuralgia:

 

  • Pain in the cheeks, jaws, teeth, lips, gums and sometimes in the forehead and eyes
  • Pain may be present in a single spot or maybe widespread
  • Pain occurs usually on one side of the face or rarely on both the sides

 

If there is facial pain, especially for prolonged periods which is recurring and does not get relieved with over-the-counter pain-relieving medicines such as paracetamol, then consult the doctor.

Causes

In most of the cases, the exact of cause trigeminal neuralgia is not known. The possible causes include:

 

  • Systemic diseases such as multiple sclerosis, Lyme disease, and sarcoidosis which cause damage to the trigeminal nerve
  • Tumors which compress the trigeminal nerve
  • Disorders which cause damage to the myelin sheath that safeguards the trigeminal nerves

 

The other causes include:

 

  • Surgical injuries
  • Facial trauma or accident
  • Stroke
  • Brain lesions
  • Triggers

 

A wide variety of daily activities can trigger pain in patients with trigeminal neuralgia. These include:

 

  • Eating
  • Drinking
  • Brushing teeth
  • Talking
  • Smiling
  • Touching face
  • Washing face
  • Shaving
  • Using makeup
  • Exposure to breeze

Risk factors

Although trigeminal neuralgia affects people of any age group, it is more common in people older than 60 years. The other factors which increase the chances of developing trigeminal neuralgia are:

 

  • A family history of the condition
  • High blood pressure
  • Female gender

Complications

People with trigeminal neuralgia are likely to develop the below complications:

 

  • Depression
  • Anxiety due to the fear of return of symptoms

Diagnosis

It is sometimes difficult to diagnose trigeminal neuralgia and the confirmation of the condition can take few years in some cases. The doctor asks for the symptoms, i.e. description of the pain in detail. Some of the questions which the patient needs to answer include:

 

  • What is the type of pain, i.e. whether it is shock-like, sudden and brief?
  • What is the location of pain?
  • What activities trigger the pain?

 

To rule out other conditions which can cause similar symptoms, the doctor will need further tests which include:

 

  • The neurological examination which involves touching various parts of the face to determine the location based on the reflexes. This helps to know which branches of the nerve are affected.
  • Magnetic resonance imaging (MRI) of the head is performed to detect the presence of a tumor or multiple sclerosis.

Treatment

Treatment helps to reduce the risk of remission. Treatment options for trigeminal neuralgia include medications and surgery as detailed below:

 

  • Anticonvulsant drugs may be prescribed to calm down the nerves and prevent them from reacting to the irritation or external stimuli. However, these drugs may cause side effects such as dizziness, drowsiness, and confusion.
  • Muscle relaxants or anti-spasmodic agents may be given either alone or in combination with anticonvulsants.
  • Tricyclic antidepressant medicines can help to ease the symptoms.
  • Botox injections may be helpful in relieving the pain in some patients.
  • If medications are not effective and the pain persists, then surgery or radiation therapy may be recommended. Several surgical options are available and the choice is based on the nerves involved and the overall health of the patient.
  •  If there any underlying conditions, then specific medications will be prescribed to remove the cause of the condition.
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