Trigeminal Neuralgia Treatment
Trigeminal Neuralgia Treatment – Let’s Walk Through This…
So, you have trigeminal neuralgia (TN) and you’re looking for pain relief…and fast! Part of your journey involves “getting smart” on your facial pain, what’s really going on, and what are the best treatment options FOR YOU!
What is Trigeminal Neuralgia?
Trigeminal neuralgia (TN) is an excruciating facial pain condition that affects one side of the face that comes in short bursts and can completely knock a person off their feet.
This pain comes from the trigeminal nerve which is a cranial nerve inside your head that connects your face to your brain.
The trigeminal nerve is like a tree in that it has a “trunk” and three larger “branches”. Each branch feels a part of the face. Inside the nerve are hundreds of “wires” that carry information from the face to the brain to tell us what is happening with our skin, eyes, teeth, etc.. Each wire carries a different kind of sensation. For example, there is a set of wires that feel hot and cold, and another set of wires that feel sharp pin-pricks and yet another that feels pressure on our teeth. These wires are bundled together like a cable in your home and are meant to send true pain signals to your brain.
Trigeminal neuralgia (TN) is an excruciating facial pain condition that affects one side of the face that comes in short bursts and can completely knock a person off their feet.
This pain comes from the trigeminal nerve which is a cranial nerve inside your head that connects your face to your brain.
The trigeminal nerve is like a tree in that it has a “trunk” and three larger “branches”. Each branch feels a part of the face. Inside the nerve are hundreds of “wires” that carry information from the face to the brain to tell us what is happening with our skin, eyes, teeth, etc.. Each wire carries a different kind of sensation. For example, there is a set of wires that feel hot and cold, and another set of wires that feel sharp pin-pricks and yet another that feels pressure on our teeth. These wires are bundled together like a cable in your home and are meant to send true pain signals to your brain.
Facial Pain – When the System Goes “Haywire”
When someone experiences “electrical shocks”, “stabbing pain” and “sharp pain” that come in short bursts (1-3 seconds) and are triggered by eating, talking, chewing, or touching their face, trigeminal neuralgia is likely.
Here, the wires inside the trigeminal nerve are starting to “short out” on each other. This happens when the insulation between wires (myelin) breaks down in spots. The breakdown of the insulation is often the result of a blood vessel pressing on and heating up the trigeminal nerve. As time progresses, the breakdown of insulation can increase and episodes of pain that used to be short and rare become more frequent and intense.
Trigeminal Neuralgia Treatment Options – What can I do about this pain?
Almost every TN patient will start treating his or her facial pain with a medication (in pill form). “First line” medications most often prescribed are in the “anti-epileptic” family of medications. These medications can be effective in treating type I and type II trigeminal neuralgia and are always a great first step. Possible trigeminal neuralgia medications include, but are not limited to, Carbamazepine (Tegretol), Oxcarbazepine (Trileptal or Oxtellar XR), Gabapentin (Neurontin), Pregabalin (Lyrica), and Baclofen.
When you start any trigeminal neuralgia medication, consider keeping a journal or tracking your medication name, dose and frequency (how many times per day you stop to take a pill) on your iPhone or mobile device [app plug here]. Also, consider tracking how the medications work for you. Is your pain gone? Do you still have moments of “breakthrough pain”? Are you experiencing any medication side effects? At higher doses, people can experience side effects such as tiredness, lethargy, feeling “druck or off balance, etc..
Most people will require adjustments to their medication over time. It’s also common that your doctor will need to try a second or third medication if you have more frequent episodes of breakthrough pain or significant side effects from one particular medication.
Microvascular decompression or “MVD” is a surgical procedure designed to create a buffer between the cranial nerve that’s “in trouble” and the blood vessel that is pushing on the nerve. MVD surgery is performed under general anesthesia. Patients are fully asleep during surgery. During an MVD, space is created by placing teflon sponges between the cranial nerve and the blood vessel. For trigeminal neuralgia, sponges are placed in between the SCA and the trigeminal nerve using an operative microscope.
MVD surgery is performed by an experienced neurosurgical team including a brain surgeon, neuro-anesthesiologist, surgical “scrub” technicians, operating room nurses and an experienced neurophysiologist. Throughout the surgical procedure, patients are kept safe by using special monitoring equipment to ensure that functions of the brain and brainstem are protected throughout the surgical procedure. Critical cranial nerves for facial movement, hearing, and swallowing are “in play”, so an experienced team is critical to preventing hearing loss, facial numbness, or other potential side effects. MVD surgery can be extremely safe and beneficial to patients. Long term, most successful MVD patients remain pain free and off medications.
Gamma Knife Radiosurgery (GKRS) is not traditional surgery. Rather, Gamma Knife Radiosurgery is a minimally invasive outpatient procedure designed to treat painful nerve disorders like trigeminal neuralgia without a knife. In the case of trigeminal neuralgia, a small “shot” of radiation is placed on the trigeminal nerve where the offending blood vessel is touching the nerve. In many cases, this location is on the trigeminal nerve just before it plugs into the brainstem. GKRS is painless and general anesthesia is not required. Patients leave the Gamma Knife facility on the same day of treatment, often before lunch, and have very few restrictions after the procedure is complete.
Percutaneous rhizotomy is a procedure designed to treat facial pain by targeting specific branches of the trigeminal nerve. To perform a percutaneous rhizotomy for trigeminal neuralgia, a needle is passed through the inside of the mouth into the base of the skull using real-time images to guide the needle. Once the needle is next to one of the branches of the trigeminal nerve, the branch is intentionally damaged using either heat (aka, radiofrequency rhizotomy), a chemical (aka, glycerol rhizotomy) or a balloon (aka, balloon compression rhizotomy).
Trigeminal Neuralgia Treatment – Summary
Now that you’re “smart” on your trigeminal neuralgia treatment options, it’s critical to find an expert to select the best journey for you.
Everyone is different and no 2 cases are identical. You need to find a professional who will listen to everything you have to say and take all of your medical information and pain history into consideration BEFORE you commit to any particular treatment.