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If you were diagnosed with trigeminal neuralgia, you were probably extremely happy to learn that there are medications that can sometimes help. On the other side of that, you may be incredibly disappointed to find your trigeminal neuralgia medication not working or meeting your expectations. This is not an uncommon occurrence and luckily, there are other treatments, including surgery, that can help bring about the total relief you have been seeking.

What Is Trigeminal Neuralgia?

Trigeminal neuralgia is the dysfunction of the trigeminal nerve. Your trigeminal nerve controls a large area of your face. When you’re experiencing the symptoms of trigeminal neuralgia you are likely experiencing intermittent, stabbing pulses and unbearable pain. Everyone experiences this condition a little differently.

These symptoms are caused by a misfiring of the nerve impulses. This is due to some sort of damage to or interference with the trigeminal nerve. In some cases, it is due to a loss of myelin, the outer coating that protects the nerve itself. In the majority of instances, however, it is due to a blood vessel pressing against the trigeminal nerve.

Medications for Trigeminal Neuralgia

The use of medications to control the symptoms of your trigeminal neuralgia should always be the first step towards helping you find relief. There are a couple of medications that have been found to be effective in treating TGN symptoms. These include Tegretol and Trileptal. These are anticonvulsants and address the cause of the pain — not just the symptoms. Narcotics are not typically used as they are addictive and only treat the symptoms for a short time.

In theory, Tegretol and Trileptal are supposed to calm the nerves overreaction to stimuli, keeping it from misfiring and causing the unbearable pain. Unfortunately, in cases of trigeminal neuralgia where there is a great deal of damage to the myelin or an impingement is present, medications tend to barely scratch the surface. There is also the possibility that the side effects caused by these medications outweigh any kind of relief they may bring.

What If the Medications Don’t Work?

If you’re finding that your trigeminal neuralgia medications aren’t working, it is time to seek a different treatment. This can include options such as surgery, radiation or even neural blocking injections.

If you’ve been taking your TGN medication as prescribed and still not experiencing relief, you need to contact your doctor. He or she can then begin to explore other treatment options to get you back to feeling like yourself.

Non-Pharmaceutical Treatment Options

Medications are usually the most conservative and first approach to treating trigeminal neuralgia. Luckily, a wide number of alternatives are available, making finding relief after medication failure a possibility.

Microvascular Decompression Surgery

The gold standard for TGN treatment after trying medication is a surgery called microvascular decompression (MVD). This procedure is most successful in young, healthy individuals. To receive MVD surgery, you must first have a FIESTA MRI to determine if your TGN is being caused by an impingement. Once you’ve passed the initial qualifying tests, your doctor will discuss this surgery with you and schedule you for the procedure.

MVD involves making a small incision at the base of your skull. A quarter-sized piece of bone tissue will be temporarily removed to give your surgeon full access to the area that needs to be operated on. Once the nerve and the blood vessel that is pressing against it are identified, your surgeon will place a tiny Teflon sponge between the nerve and vessel. This effectively prevents the two from touching and helps absorb the impact caused by the blood moving through the artery. Most people have immediate relief of their TGN symptoms after a microvascular decompression and don’t experience the numbness that can come with other procedures.

Gamma Knife Radiosurgery

If it’s been determined that you are not eligible for receiving MVD surgery, your next best option is Gamma Knife Radiosurgery (GKRS). This procedure is recommended for those that could not withstand undergoing anesthesia or may have TGN that is not caused by an impingement. You are awake the entire time and there is no pain involved. Most patients also go home the same day.

Gamma Knife Radiosurgery uses around 200 tiny beams of radiation to treat an area. The individual rays are, on their own, fairly innocuous. However, when they converge on a target, they combine to deliver a therapeutic dose of radiation. This method is ideal in that it can be finely tuned to treat the tiniest of areas and does not cause damage to the surrounding tissues or the tissues each beam initially passes through.

In the case of trigeminal neuralgia, GKRS causes a tiny amount of damage to the injured or compromised part of the nerve, rendering that portion of the nerve incapable of transmitting nerve impulses.

Percutaneous Rhizotomy

If the first two options aren’t feasible you can still undergo a percutaneous rhizotomy. This involves using local anesthesia and inserting a long needle into the area of the trigeminal nerve. Heat, a balloon compression device or glycerol are then transmitted through this probe to create an injury to one or more selected nerve branches to arrest painful impulses.

Stimulator Placement

Another option for trigeminal neuralgia pain relief is the placement of pain stimulators. This involves placing a small electrode near the portion of your trigeminal nerve that is producing the painful sensations. These electrodes deliver small electrical pulses that disrupt the pain signals.

Initially, a trial run will be performed to make sure your pain responds well to this treatment. Once it’s been determined that it’s successful, a permanent stimulator will be placed beneath your skin and connected to the electrodes.

Although medication failures can be disappointing, it’s heartening to know that there are a number of other treatments available for your TGN. You can find the relief you need to regain your life and get back to the most important job of all – living it!
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