Trigeminal neuralgia (TN) is also often referred to as Tic Douloureux. It is a pain usually in the lower part of the jaw and is known to be the most excruciating pain for human beings. It may also affect the nose and eyes, depending on the severity of the pain. The pain is defined as sharp, throbbing, electric-shock-like pain.
The pain is usually limited to one side of the face. The pain in trigeminal neuralgia is known to be unpredictable and sudden in onset.
Trigeminal neuralgia is considered to affect the quality of life of an individual, and the person may undergo depression, isolation, and weight loss. Patients may also have difficulty eating as the pain may trigger slight irritation.
What is a Trigeminal Nerve?
The human body consists of twelve cranial nerves. These nerves supply essential body parts and have sensory and motor functions: the fifth cranial nerve, the trigeminal nerve, further branches into three.
- Ophthalmic branch: It supplies to function of the eye, upper eyelid, and forehead.
- Maxillary branch: It supplies the lower eyelid, nostril, cheek, and gums of the maxilla and upper lip.
- Mandibular branch: it supplies the lower jaw, mandibular gums, lower lip, and masticatory muscles.
What Causes Trigeminal Neuralgia?
The exact cause of trigeminal neuralgia is still unknown. However, the expected causes have been divided into two.
- Primary Trigeminal Neuralgia
Primary trigeminal neuralgia is diagnosed when an artery or a vein compresses over the trigeminal nerve. The compression is usually at the base of the skull. The pressure due to the compression leads the nerve to misfire, which causes pain.
- Secondary Trigeminal Neuralgia
It happens when the pressure on the trigeminal nerve is from a cyst, a tumor, or damage to the myelin sheath.
The onset of pain is sudden and can be triggered by even slight activity. The activity can be eating, washing the face, touching the face, or even brushing the teeth. Occasionally, a breeze of air or even a slight head movement may trigger the pain.
How Common is Trigeminal Neuralgia?
TN is known to affect individuals of older age between forty to fifty years of age. It mainly affects women more than men. It is approximated to affect 150,000 people around the globe annually. However, it is considered a rare disorder.
How to Treat Trigeminal Neuralgia?
The treatments are divided mainly into non-surgical and surgical interventions. In addition, some treatments may work for one patient while not for another; the remedies are discussed briefly below.
Non-Surgical Treatment for Trigeminal Neuralgia
Several medications are available as non-surgical pain relief interventions. The medicines are prescribed in low doses initially as the response varies from patient to patient.
It is an anticonvulsant drug and is commonly used to treat TN. For most people, it is effective during the initial phases. However, the possible side effects of carbamazepine include nausea, drowsiness, dizziness, and double vision.
The anticonvulsant drug is mainly prescribed as an anti-epileptic and to treat migraines. Gabapentin has lesser side effects that include drowsiness and dizziness.
Oxcarbazepine is a newer drug that is now given as the first drug of choice to treat trigeminal neuralgia. It belongs to the carbamazepine family and carries fewer side effects, such as double vision and dizziness.
Other medications are known to treat trigeminal neuralgia, such as pregabalin, sodium valproate, amitriptyline, phenytoin, opioids, etc. But these drugs may require higher doses which may lead to adverse effects. The drugs may also lead to immunosuppression; close monitoring is essential.
When oral medications are not effective in treating the symptoms of TN, the next best option is surgical intervention. Some of the popular procedures to treat trigeminal neuralgia are discussed below.
Gamma knife radiosurgery, despite its name, is a non-invasive procedure with highly focused radiation beams. The radiation disrupts the signals shooting from the nerve; therefore, they don’t reach the brain. The procedure has shown success in 80% of cases.
Balloon compression treats TN by inflating a balloon that compresses the trigeminal ganglion. As a result, it disrupts the imparting signals, reducing pain.
The procedure numbs the trigeminal nerve by injecting glycerol (alcohol) into the area of the affected nerve space. The shot helps reduce the pain and suffering.
- Radiofrequency Ablation (RFA)
RFA helps reduce pain by removing the affected tissue. The procedure is done by using high-frequency heat on the targeted nerve. As a result, the nerve loses the ability to transmit signals to the brain; therefore, no pain is felt.
The procedure is open cranial surgery. It is performed to relieve the abnormal compression of the trigeminal nerve. A sponge is placed between the nerve and the artery or vein that causes nerve compression, leading to abnormal pain signals.
Watch this video: Trigeminal Neuralgia
What Can Be Mistaken for Trigeminal Neuralgia?
Many diseases may have similar signs and symptoms as that of trigeminal neuralgia. Therefore, proper history and examination are critical to diagnosing a particular disease. Some of the possible diseases are described below.
Postherpetic neuralgia (PHN) is a complication of varicella-zoster virus (VZV). It mimics sharp shooting, electric-shock-like pain similar to that of trigeminal neuralgia. The disease is common in immunocompromised adults.
Hemifacial spasm is a disorder of neuromuscular origin. It is characterized by abnormal eyelids twitching on one side of the face. It may also affect the muscles of the lower face leading to drooping of the face to the affected side.
Migraine headaches are also known to affect one side of the face, similar to that in trigeminal neuralgia. Usually, the pain intensity is different; however, the intensity of pain differs from person to person.
Bananas and Trigeminal Neuralgia
Although, no definitive studies are present to prove the basis of the fact that bananas reduce the pain of trigeminal neuralgia. On the other hand, trigeminal neuralgia is thought to hurt less if you eat fruits high in potassium, iron, and vitamin B6.
Bananas contain tryptophan, which induces the neurotransmitter serotonin. Serotonin plays a vital role in mood regulation and the management of pain; therefore, the banana theory is liked by some doctors, while some suggest it only be a theory.
If any of your loved ones suffers from trigeminal neuralgia, a consultation with a neurologist is crucial. In addition, the prescribed medications may help the patient lead a better life, as trigeminal neuralgia is known to affect the quality of life.
Although not fatal, trigeminal neuralgia brings depression and anxiety to one’s life. Understanding the suffering of the patient and their surroundings is significant. If surgery is suggested, ruling out the procedures’ benefits and risks is equally important. Visit Eve Pacific Health to learn more.