Working with your doctor to reach a diagnosis of trigeminal neuralgia can be a complicated process. You and your doctor have worked through where your pain may be originating from, how long the pain lasts, how severe it is, and what complicating medical issues may be playing a role.
For atypical trigeminal neuralgia, the process is even more complicated. The symptoms caused by atypical trigeminal neuralgia, also known as trigeminal neuralgia type 2, can masquerade or be misdiagnosed as being related to dental issues, migraines or even multiple sclerosis. In addition, atypical trigeminal neuralgia may occur at the same time as one of those other disorders. Now that you have reached your atypical trigeminal neuralgia diagnosis, you may be wondering what comes next. Here’s an idea of what you can expect.
Medical Management of Atypical Trigeminal Neuralgia
After your atypical trigeminal neuralgia diagnosis, the first step is medication. The pharmaceuticals most commonly used are anti-seizure medicines, including Trileptal (generic: oxcarbazepine) and Tegretol (generic: carbamazepine). Additional drugs your neurologist may consider include Lamictal (generic: lamotrigine), Dilantin (generic: phenytoin), Klonopin (generic: clonazepam) or Neurontin (generic: gabapentin).
Some doctors and patients also find success through the use of tricyclic antidepressant medications like Elavil (generic: amitriptyline). While some neurologists prescribe opioid drugs instead, this is not the recommended course of treatment. Opioids can be highly addictive and will not address the root cause of your trigeminal neuralgia. As an atypical trigeminal neuralgia patient, you may need to take several different types of anti-seizure medications before the right formulation and dosage are determined.
When Medical Management Doesn’t Work
While managing atypical trigeminal neuralgia through medications is the preferred treatment, it is not effective in all patients. You may find that medicinally managing your trigeminal neuralgia can fail in two different ways: being overrun with undesirable side effects or not effectively addressing your symptoms.
The types of side effects that you may experience include:
- Extreme fatigue or all-day drowsiness
- Mind fog or confusion
- Feeling drunk or disoriented
Those are all serious side effects and should be discussed with your neurologist when they occur. Your body may take a few doses to acclimate to new medications, but when worrisome side effects happen after the first few days, they can be a sign that your body will not tolerate that particular pharmaceutical and perhaps another should be tried. The purpose of medical management is to give you your life back as you escape from the debilitating pain of trigeminal neuralgia, and that cannot happen if medications cause more issues than they fix.
The other way you can fail medical management of your atypical trigeminal neuralgia diagnosis is because medications do not work for you at all or only bring minimal pain relief. Again, it can be a long process to try different medications and still not achieve relief, but surgical interventions should only ever be considered if medical management has completely failed.
Surgical Options for Trigeminal Neuralgia
If you and your neurologist have exhausted all avenues of medical management, you’ll be referred to a neurosurgeon who specializes in facial pain management and can perform the appropriate procedure that your unique health history matches up to. Here’s a look at the procedures your neurosurgeon will work with you to choose between.
Microvascular Decompression
If your imaging scans shows an impingement on your trigeminal nerve, your neurosurgeon may recommend microvascular decompression. During this procedure, the surgeon will create a small opening in your skull behind your ear. Within that hole, he’ll access your trigeminal nerve and place a small sponge between it and whatever blood vessel was causing the impingement. This is considered major surgery, however, so your doctor will thoroughly consider your health history before you are determined to be a candidate.
Gamma Knife Radiosurgery
If you are not a candidate for microvascular decompression, the next procedure you and your neurosurgeon can consider is Gamma Knife Radiosurgery. Technically, this is a radiation-based intervention, not an invasive surgery. To perform Gamma Knife Radiosurgery to address your atypical trigeminal neuralgia diagnosis, you will be placed in a head frame. Once secured, multiple beams of radiation will target your trigeminal nerve. This radiation will confuse that nerve and disrupt its ability to signal pain.
Percutaneous Rhizotomy
The next procedure you and your doctor may consider is percutaneous rhizotomy. This procedure involves threading a small needle into your cheek on the side where your atypical trigeminal neuralgia is aligned. A bit of heat will flow through that needle and destroy a small portion of the trigeminal nerve, removing the nerve’s ability to signal pain. With this procedure, you may experience a little facial numbness in exchange for the ending of pain.
Pain Stimulator Implant
The final procedure you and your doctor may consider is the implantation of a pain stimulator. Pain stimulators confuse the messages sent by nerves and by doing so, can eliminate pain. The stimulator and its battery pack is placed beneath your skin, and you, as the patient, have the ability to control its use. You can increase or decrease stimulation as your symptoms indicate.
Next Steps for an Atypical Trigeminal Neuralgia Diagnosis
Your most important step after receiving your atypical trigeminal neuralgia diagnosis is finding and working with a doctor who specializes in facial pain and with whom you can best decide your course of treatment.
