If you think you may have Trigeminal Neuralgia (TGN), you’re probably wondering if you’ll ever find relief from this debilitating condition. Luckily, there are a number of treatment options available that will put you on the road to recovery from the symptoms of TGN.
What Do I Do First?
If you think you have trigeminal neuralgia, whether you’ve come to this conclusion yourself or you’ve had a medical professional identify it, you need to seek the help of a specialist to rule out other possibilities. Before beginning your path towards treatment, it’s imperative that you first get a definitive diagnosis from a neurologist who specializes in facial pain, and especially trigeminal neuralgia. Your general practitioner should be able to refer you to a reputable TGN specialist, or you can seek them out yourself with a bit of research. Never hesitate to get a second (or even third) opinion — this is your health and quality of life at stake.
I’ve Been Diagnosed… Now What?
Once you’ve been properly diagnosed by a trigeminal neuralgia expert neurologist, you can start to explore your options for treatment. There are more available than in the past, giving every sufferer a chance to achieve relief.
Your first course of action after you’ve been diagnosed with trigeminal neuralgia is to try medication to control the pain and discomfort. The past decade has seen great advances in nerve pain medication development. At this point the gold standard for TGN medications includes Tegretol and Trileptal. Both of these medications work differently than narcotic pain management drugs and are luckily not addictive. Narcotics will not treat the root problem of trigeminal neuralgia, making them poor candidates for trigeminal neuralgia intervention.
If for some reason, you are taking the highest dose of one or more of the appropriate medications and still experiencing symptoms, you may not be a good candidate for drug treatment. This is called “breakthrough pain” and happens in a small percentage of trigeminal neuralgia sufferers. There is also the possibility that you experience side effects from the medication(s) prescribed to you (including fatigue, a “foggy” feeling or drowsiness), indicating you may need to move on to the next option.
Should you choose not to follow the drug therapy route, or are unable to for some reason, then by far the next best course of action would be to seek out an experienced neurosurgeon well versed in the treatment of trigeminal neuralgia. If you’re a healthy young adult, the neurosurgeon can assess you for a surgical procedure known as microvascular decompression (MVD). You should undergo a high-resolution MRI, often referred to as a FIESTA MRI, to determine your candidacy for microvascular decompression.
On this MRI study, many TGN sufferers are found to have a blood vessel pressing up against the trigeminal nerve, causing irritation of the nerve and the subsequent pain and discomfort. In the MVD procedure, a skilled neurosurgeon will isolate the nerve and offending blood vessel. A very small Teflon pad is then strategically placed between the nerve and vessel, essentially creating an insulative buffer between the two structures. Without the regular, pulsing pressure from the blood supply irritating the nerve, relief is typically instantaneous.
If you are not a candidate for microvascular decompression (there can be many factors, including the root cause of your trigeminal neuralgia), you still have a few other trigeminal neuralgia treatment options available to you.
Gamma Knife Radiosurgery
It may sound like something out of a science fiction novel, but Gamma Knife Radiosurgery is a highly effective means of treating trigeminal neuralgia in those that don’t respond well to drug therapy or aren’t candidates for microvascular decompression.
Gamma Knife Radiosurgery is a non-invasive procedure using around 200 focused beams of radiation to isolate and destroy offending tissue(s). It is generally well tolerated by the patient and is a great option for those too medically fragile to undergo MVD surgery. The side effects can also be lower in some individuals — your neurosurgeon will be the best source of information on whether this is the best option for your trigeminal neuralgia treatment.
I’m Not a Candidate for Any of the Above. What Else Can be Done?
If your specialists have determined that you are not a good candidate for the other trigeminal neuralgia treatment options such as medication, microvascular decompression or Gamma Knife Radiosurgery, there are still two interventions that can be considered.
The first is percutaneous rhizotomy, a minimally invasive procedure in which some of the nerve fibers in the offending nerve are damaged or destroyed, making them unresponsive to stimuli. This is typically an outpatient procedure. Results can be partial or complete, but the damage caused to the nerve may come with permanent numbness or other minor discomforts.
The second option is the placement of pain stimulators. In this moderately invasive procedure, tiny electrodes are guided to the nerve and attached to a battery pack placed under the skin. The electrical signals sent out by the stimulators intercept the nerve impulses, preventing the signals from reaching the brain. This is often a last resort, but is still a viable option for those suffering from trigeminal neuralgia.
As you can see, you have many options for treating the symptoms of your trigeminal neuralgia. Once you’ve received a definitive diagnosis and sought out the care of a neurologist — and possibly a neurosurgeon — you can begin to fully explore all of the different trigeminal neuralgia treatment options.