Q: I read your articles daily and have gotten a lot of GOOD information from them. Thank you. I am being treated for trigeminal neuralgia. What are your thoughts and recommendations on this disorder?
A: The trigeminal nerve is a paired cranial nerve that has three primary branches – the ophthalmic nerve (V1), the maxillary nerve (V2) and the mandibular nerve (V3). Any or all of these nerves can be affected, however the branch most commonly affected is the V2.
Trigeminia neuralgia, also known as tic douloureux, is a neurological disorder of the trigeminal nerve characterized by episodes of inflammation that cause severe facial pain. The pain may occur sporadically appearing every few seconds, minutes or hours, or may present only once with months or even years between attacks. Interestingly, between attacks there will be no symptoms or pain. While individuals of any age can be affected, it is more common in women rather than men, in individuals 60 or older, and affects the right side of the face more frequently than the left by a five to one ratio. In some instances the nerve can be compressed by blood vessels nearby, a tumor, or aneurysm; however, in many cases, the cause remains unknown.
Symptoms include acute, stabbing pain most commonly to one side of the face that generally begins at the angle of the jaw and radiates from there. The pain may worsen in intensity with the simple act of chewing, having cold food or cold eating utensils in the mouth, or even because of simple touching. Individuals will likely shield their face to prevent the pain from being touched which is a clear diagnostic tool recognized by physicians.
Idiopathic trigeminal neuralgia may not require testing in order to define it. However, an MRI may be used to determine whether a tumor or multiple sclerosis may be irritating the trigeminal nerve. The International Headache Society has established a criteria for diagnosing the disorder. There may be no clinically evident neurological deficit; the pain must be intense, sharp, superficial or stabbing and precipitate from trigger areas or trigger factors; the attacks may last from a nanosecond to two minutes and affect one or more divisions of the trigeminal nerve; attacks should be stereotyped in the patient; and the symptoms cannot be attributed to another disorder.
Treatment may involve the physician prescribing a single anti-convulsant drug such as carbamazapine (Tegretol) being a general choice. Gabapentin may be added as a second line treatment, often in addition to the anti-convulsant. Further, Botox injections have met with some success. Should medication fail to provide relief of symptoms, surgery or radiation therapy may follow, although the evidence for surgical therapy being successful remains poor since there may be some relief from pain but numbness following the procedure may result. Still, physicians have other potential treatments such as microvascular decompression (a major neurological procedure) that appears to result in a longer period of diminished pain or ablating the nerve.
My recommendation is that you follow your physician’s advice and treatment plan. Ask if such things as acupuncture, chiropractic adjustment, meditation or self-hypnosis might be tried for relief from the pain involved.
