Trigeminal Neuralgia

What is trigeminal neuralgia, and what are the symptoms?
  • Trigeminal neuralgia is an illness where pain arises because of the trigeminal nerve
  • Depending on which branch is affected, we may felt trigeminal neuralgia pain over the eye, cheek or jaw area
  • It only affects one side of the face at a time
  • Pain can be stabbing, electrical and severe, such that the person can’t do anything or even eat or drink
  • The pain lasts for seconds initially but may last for minutes or longer. In the intervening period between attacks, there will be no pain.
What are the causes of trigeminal neuralgia?
  • It usually happens spontaneously i.e. bad luck, but occasionally, it can happen after a surgery or dental procedure due to damage to a branch of the trigeminal nerve
  • Sometimes it is from a blood vessel pressing on the nerve deep in the brain. The pulsation of the artery wears the outer covering of the nerve, leading to increased sensitivity
  • Rarely, the condition is due a tumour or multiple sclerosis 
How can you treat trigeminal neuralgia?
  • Medications
    • Carbamazepine is usually tried first after a blood test to exclude a serious idiosyncratic reaction
    • Gabapentin and pregabalin can also be tried 
  • Pain procedures
    • Trigeminal or sphenopalatine blocks or radiofrequency
  • Surgery to decompress the nerve when there is evidence of vascular compression on the MRI
  • Gamma knife surgery: can be effective but requires more radiation; may need to be repeated

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