Trigeminal Neuralgia is a chronic condition caused by compression of the Trigeminal nerve and resulting in excruciating pain (most commonly) in the lower part of the face.
There is no permanent cure for Trigeminal Neuralgia but here are some treatment guidelines that prove relief from the pain temporarily.
- Identification and avoidance of triggers
- Medications
- Percutaneous procedures
- Radiological processes
- Surgical procedures
- Complementary long term techniques
- Draw-backs
1- Identification and avoidance of triggers
Different individuals have different triggering factors. It is important to figure out the specific triggers and avoid them. Some of the triggers include:
- Chewing.
- Drinking warm or cold drinks.
- Strong winds.
- Draught.
- Certain foods that might trigger an attack are; caffeine, lemons, and other citruses.
2- Medications
The severe pain, characteristic of Trigeminal Neuralgia cannot be treated using a simple analgesic. Other medicines are prescribed to help with the pain.
Oral medications:
Anticonvulsants:
People who have frequent attacks of pain, need to take anticonvulsants on a regular basis. However, they can temporarily stop these during the period of remission. Some of the anticonvulsants are:
- Carbamazepine
- Gabapentin
- Phenytoin
- Topiramate.
Carbamazepine being the only licensed drug to provide pain relief in trigeminal neuralgia.
None of these medicines provide permanent relief from the pain. Patients tend to develop tolerance towards these medicines with the passage of time.
Tricyclic antidepressants:
They provide sedative action against severe pain. Including:
- Amitriptyline
- Nortriptyline.
Muscle relaxants:
These are mostly given with anticonvulsant drugs.
Baclofen is one important muscle relaxant
Injectables:
Nerve block:
- Botulinum toxin injection is used to block the sensations from nerves. These only provide temporary relief.
Over time, the patient develops tolerance against these medicines, and they stop working for him. At this point, percutaneous, Radiological, and open surgical procedures can help with the pain.
3- Percutaneous procedures
Rhizotomy :
This involves the complete destruction of nerve fibers by applying heat, that are responsible for the pain. There are several ways to carry out Rhizotomy.
Glycerol injection:
Glycerol is injected at the point where three main branches of the Trigeminal nerve join together to form a ganglion, Gasserian ganglion, disrupting the signal transmission to the brain from pain receptors.
Balloon compression:
A balloon is used to damage the pain-causing nerve fibers. The procedure involves passing a needle through the cheek and then using that Needle to pass a catheter and a balloon. The balloon is inflated, which compresses the nerve and damages the fibers.
4- Radiological processes
A beam of radiation is used to cause damage to the Trigeminal nerve root, This procedure is not invasive and can be done under local anesthesia and shows results in a few weeks time.
Radiofrequency lesioning (RF ablation):
Direct heat is applied to the Gasserian ganglion, (the point where three main branches of Trigeminal nerve meet) using a needle.
Stereotactic radiosurgery:
This involves the slow formation of a lesion on the nerve by focusing high energy beams of radiation at the Gasserian ganglion. This inhibits the sensory signals for pain being transmitted to the brain.
5- Surgical procedures
Microvascular decompression:
The procedure involves removing or replacing the blood vessels which are compressing the Trigeminal nerve underneath. The procedure requires making an opening in the skull and is quite invasive.
However, this has proved successful in 70% of patients.
Neurectomy:
In cases, where no blood vessel is compressing the nerve. A part of the nerve is cut out, this is most commonly carried out on the superficial branches of Trigeminal nerve in the face.
6- Complementary long term techniques
Some individuals might opt for complementary approaches along with medical treatment. This can offer varying degrees of relief to different individuals.
Some of these are:
Yoga, Meditation, Aromatherapy, Vitamin therapy, Nutritional therapy, Low impact exercises, Acupuncture, and Chiropractic procedures.
Some individuals might go for supportive counseling along with other treatment options.
7- Draw-backs
All these Trigeminal Neuralgia Treatment Guidelines cause loss of sensation and numbness in areas supplied by the Trigeminal nerve. In some procedures like neurectomy, (carried out on the superficial branches), the nerves might grow back and the pain may return, in a few years’ time.
FAQ
Carbamezipine is the only licensed drug to provide pain relief in Trigeminal Neuralgia. However, there are other anti-convulsants too.
Some of these are:
Yoga, Meditation, Aromatherapy, Vitamin therapy, Nutritional therapy, Low impact exercises, Acupuncture, and Chiropractic procedures are a few examples.
Surgical and any other procedure to treat Trigeminal Neuralgia, cause loss of sensation and numbness in areas supplied by the Trigeminal nerve. In some procedures like neurectomy, the nerves might grow back and the pain may return, in a few years’ time. So, these are not even permanent treatments.
Botullinium Toxin, more commonly known as Botox is used to block the sensations from nerves to be transmitted to the brain. This is a temporary treatment to help patient with the pain.
