Trigeminal neuralgia, or TGN, can take over your life. This debilitating and painful condition affects approximately 140,000 people in the United States; around 14,000 new cases are diagnosed yearly.
Trigeminal nerve pain, associated with trigeminal neuralgia, affects the fifth cranial nerve — the nerve that is responsible for sensation from multiple areas of your face, including your cheeks, jaw and temples.
When you are suffering from this specific type of trigeminal nerve pain, it is due to a dysfunctioning trigeminal nerve. Essentially, the nerve’s impulses that carry information from your face to your brain and back again are misfiring, creating painful sensations. This dysfunction can be caused by damage or trauma to the trigeminal nerve or compression of the nerve by a blood vessel that runs adjacent to it.
The sensations created by these “misfirings” have been likened to intense electric shocks to one side of the face. Each episode usually only lasts a few seconds but can occur from a few times a day to multiple times per hour.
There are treatment options that can help you find relief from your trigeminal nerve pain.
Medications for Trigeminal Nerve Pain
Through a great deal of research, it has been found that certain medications work more effectively for trigeminal nerve pain than others. Medication is typically the first line of defense against trigeminal nerve pain. Your doctor may want you to try medication for a few weeks or even months before recommending further treatments.
Anticonvulsants
Anticonvulsants have proven to be incredibly helpful in the treatment of trigeminal nerve pain. Two in particular, Tegretol and Trileptal, have proven to be effective in treating some cases of trigeminal nerve pain. Both of these drugs have a direct effect on the nerves and how the impulses travel along them. The main drawback to these drugs is the wide array of side effects. These include dizziness, headaches, a feeling of inebriation and nausea, amongst others. Sometimes these side effects are too intense to continue taking the medication.
In other instances, it’s possible for the medication to stop working. Higher and higher doses are required until the maximum dosing is reached and still doesn’t provide adequate relief. At this time, it’s a good idea to explore other treatment options with your doctor.
Narcotic Painkillers
Because trigeminal nerve pain is due to nerve irritation or damage, narcotics are not a good option for this type of pain. They do not treat the unpleasant sensations adequately. Narcotics are also highly addictive and should not be used long-term.
Non-Steroidal and Steroidal Anti-Inflammatories
Both NSAIDs (non-steroidal anti-inflammatories) and corticosteroids provide very little to no relief for trigeminal neuralgia. Because both of these types of drugs can have serious side effects from long-term use, they are not recommended for trigeminal nerve pain.
Surgery
If you have found anticonvulsants to be ineffective for your trigeminal nerve pain, surgery may be the next step in your treatment. There are a few surgical procedures that have proven to be effective in long-term relief of the symptoms associated with trigeminal neuralgia.
Microvascular Decompression
Currently, the most effective surgery available for trigeminal nerve pain is a procedure known as microvascular decompression (MVD). Depending on the cause of your trigeminal nerve pain, it may be the right option for you. This procedure is only effective in trigeminal neuralgia that is caused by compression of the nerve from a blood vessel. To qualify as a candidate for microvascular decompression, your trigeminal nerve pain must be caused by this type of compression. You must also be in good health and able to withstand general anesthesia. To determine the cause of your trigeminal neuralgia, a special test known as a FIESTA-MRI must be performed. This will allow your doctor to see where all the veins, arteries and nerves run with respect to one another.
If it’s determined you’re a good candidate for MVD, you will be scheduled for surgery. Your surgeon will create a small opening in the bone at the base of your skull, about the size of a half-dollar coin or smaller. Using special instruments, the nerve and blood vessel will be located. Then, a tiny sponge made of Teflon will be placed between the nerve and vein or artery where they touch, creating a cushion. This effectively prevents the blood vessel from being able to pulse or rub against the nerve. The nerve function will be tested, your skull closed and you will begin your recovery.
You can expect the recovery time for microvascular decompression to take about 2-4 weeks. The first few weeks will require the most attention to detail — you’ll need to take your pain medications as prescribed. Your activities, such as lifting heavy objects, will be limited, and you will tire more easily. Getting plenty of rest, taking regular, short walks and eating a balanced diet will go a long way toward ensuring an uneventful recovery. During this time, it’s important to follow your surgeon’s orders and limit activity as recommended. You will also need to attend all of your follow-up appointments so that your progress can be accurately monitored.
You may feel like there is no end to your trigeminal nerve pain in sight. However, when you work with an experienced team of doctors, including a neurologist and a neurosurgeon, you can begin to explore the possibilities of a pain-free life again.
