I Am in Need of Trigeminal Neuralgia Treatment
Trigeminal Neuralgia is a chronic and severe pain condition that affects one or more branches of the trigeminal nerve. Sensations from your face and scalp are carried by this nerve to your brain. With Trigeminal Neuralgia the pain is almost always excruciating, and it can get worse over time.
At the Sydney Migraine Clinic, we have treated countless patients with Trigeminal Neuralgia with impressive results.
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Understanding Your Headache
Symptoms of Trigeminal Neuralgia
With Trigeminal Neuralgia, attacks may last anywhere from a fraction of a second, up to 2 minutes and occasionally longer. Additionally, the attacks may present as either shock-like, stabbing, shooting or sharp pain on one side of the face.
The frequency of attacks can be anything from 1 to 50 attacks per day. The facial pain is almost always severe in nature and may become more severe over time. This type of nerve pain can feel sharp, electric, or stabbing, often interfering with basic daily activities. Sufferers of trigeminal neuralgia pain may also experience tearing or redness in the eye on the same side as the pain.
Sufferers of Trigeminal Neuralgia are often extremely hypersensitive and report that even slight stimuli can cause painful attacks, sometimes lasting as little as seconds, or as long as minutes. Stimuli such as:
- Touching the face
- Brushing teeth
- Chewing, or even
- Speaking
- Even a cool breeze
Typically, the condition is more common in women (60%) than men (40%) and is more likely to occur in people aged over 50 years old.
Understanding Your Headache
What is the Cause of Trigeminal Neuralgia?
Since Trigeminal Nerves are one of the largest nerves supplying the face and head, Trigeminal Neuralgia can have many causes. A common theme among many Trigeminal Neuralgia sufferers is that they have a sensitised brainstem.
A sensitised brainstem will perceive nonthreatening stimuli (such as brushing your teeth) from the Trigeminal Nerve as a potential threat and will react, creating debilitating pain where the sensory information was originally detected. This hyperexcitability of the pain sensation is due to the heightened arousal and sensitive brainstem. A sensitive brainstem will relay the sensory information to the brain, but will heighten the sensation so that the brain perceives the information as painful.
Normal daily activities, such as touching the head or face, can become “triggers” that transmit pain signals to the brain.
How is Trigeminal Neuralgia Diagnosed?
Trigeminal neuralgia is typically diagnosed through a comprehensive evaluation that includes a review of your medical history, a physical examination, and often imaging tests. Healthcare professionals focus on the nature, location, and frequency of your facial pain to identify patterns consistent with trigeminal neuralgia symptoms. They may also assess for facial numbness, muscle weakness, or other neurological signs.
MRI scans are commonly used to diagnose trigeminal neuralgia by detecting possible compression from an offending blood vessel on the trigeminal nerve, or to rule out other neurological disorders such as multiple sclerosis. In some cases, your response to medications like anticonvulsants may also help confirm the diagnosis.
How is Trigeminal Neuralgia Diagnosed?
Trigeminal neuralgia is typically identified through a comprehensive assessment involving medical history, physical examination, and sometimes imaging tests. Healthcare providers inquire about the nature and triggers of facial pain, conduct a thorough physical examination to check for sensory abnormalities or muscle weakness in the face, and may order imaging tests like MRI to rule out other potential causes. Additionally, response to certain medications commonly used for trigeminal neuralgia, such as anticonvulsants, can provide further diagnostic insight. Through this process, healthcare professionals aim to accurately diagnose trigeminal neuralgia and tailor treatment strategies to alleviate symptoms effectively.
Types of Trigeminal Neuralgia
Classical Trigeminal Neuralgia (Primary Trigeminal Neuralgia)
This subcategory of Trigeminal Neuralgia (TN) refers to a patient that develops the disorder without apparent cause, apart from neurovascular compression. This means that the nerve itself has become damaged as a direct result of compression from the vascular system i.e. the veins and arteries. This normally happens at the site of the trigeminal nerve root, in the brainstem.
Classical Trigeminal Neuralgia can further be split into “Purely Paroxysmal” and “with Concomitant Continuous Pain” with the former being associated with pain-free periods between attacks, and the latter being associated with more mild pain between attacks.
Atypical Trigeminal Neuralgia
This subtype of trigeminal neuralgia presents with facial pain that is less severe and more constant compared to classic TN. The pain is often described as dull, aching, burning, or stabbing and may involve multiple branches of the trigeminal nerve.
Secondary Trigeminal Neuralgia
This subcategory of Trigeminal Neuralgia refers to a patient that develops the disorder as a result of an underlying disease.
Recognised causes are Multiple Sclerosis, a tumour in the cerebellopontine angle, or arteriovenous malformation.
Trigeminal Neuropathic Pain (TNP)
Trigeminal neuropathic pain is a broader term that encompasses various chronic facial pain syndromes resulting from damage or dysfunction of the trigeminal nerve. It may include conditions such as postherpetic neuralgia (resulting from shingles), traumatic neuropathy (due to facial trauma), or other neuropathic pain disorders affecting the trigeminal nerve.
Idiopathic Trigeminal Neuralgia
This subcategory of Trigeminal Neuralgia refers to a patient that experiences symptoms consistent with Trigeminal Neuralgia, however, they demonstrate no obvious abnormalities via electrophysiological tests or MRIs. Much like Classical Trigeminal Neuralgia, this diagnosis may suggest pathology of the brainstem.
Trigeminal Neuralgia may also be split into “Purely Paroxysmal” and “with Concomitant Continuous Pain” with the former being associated with pain-free periods between attacks, and the latter, associated with more mild pain between attacks. Persistent idiopathic facial pain in between severe attacks is seen in around half of all Trigeminal Neuralgia sufferers.
It is not uncommon for Trigeminal Neuralgia sufferers to go undiagnosed for long periods of time or even misdiagnosed, as the symptoms presented can be similar to those of Migraine Headaches, or Cluster Headaches.
Common Treatments for Trigeminal Neuralgia
Many patients diagnosed with Trigeminal Neuralgia are initially prescribed medications such as muscle relaxants or anti-seizure drugs. These can help block pain signals and provide temporary pain relief. Over-the-counter pain relief medication, strong anticonvulsant/antispasmodic medications, Botox injections, and even surgical treatment are among the commonly attempted approaches to addressing trigeminal neuralgia symptoms. While these may help some individuals, they often lose effectiveness over time or result in side effects that impact daily life.
Surgical procedures, such as microvascular decompression, aim to relieve pressure from an offending blood vessel compressing the trigeminal nerve. While surgery can be effective for certain patients, it also carries significant risks, including facial numbness, hearing loss, stroke, and even death. Despite the wide range of treatments available, many patients still experience painful attacks. When this occurs despite medication or surgery, the condition is often referred to as refractory trigeminal neuralgia.
I’ve already tried everything! What else can be done to help my Trigeminal Neuralgia?