What is Trigeminal Neuralgia?What is Trigeminal Neuralgia? Rather than being a severe headache, Trigeminal Neuralgia is a severe pain in the face. The following list summarises the main symptoms:
I would add that it is estimated that out of every 100,000 people, there are 2 new cases of trigeminal neuralgia appearing for the first time each year. What is Trigeminal Neuralgia's cause?In most cases the cause is attributed to "vascular loop" compression of the trigeminal nerve as it enters the brainstem at the level of the lower pons. At this point the superior cerebellar artery or a branch of it can come into close contact with the trigiminal nerve. This physical contact is thought to strip the trigeminal nerve of its myelin sheath, making the nerve excitable and produces the pain. Tumours are a very rare cause of trigeminal neuralgia, and if present are usually benign such as meningioma or schwannoma. Swelling of the basilar artery (basilar aneurysm) is another rare cause. An MRI scan of brain will reveal any underlying cause, and even modern multi-slice CT scans will exclude major pathology at the skull base if MRI is contraindicated.What is Trigeminal Neuralgia's Treatment?What is Trigeminal Neuralgia's Treatment?Trigeminal neuralgia treatments include:
Other drugs which can be used, but have been less rigorously studied than those above include: What is Trigeminal Neuralgia's Outlook or Prognosis?What is Trigeminal Neuralgia's Outlook or Prognosis?In the short term almost everybody (>90%) will respond to trigeminal neuralgia treatment (like Carbamazepine) within 48 hours. Some studies have followed people on Carbamazepine for over 15 years. Over the long term, Carbamazepine did become less powerful, with just over 50% having long term control. Another 10% will experience significant side-effects leading to Carbamazepine withdrawal. People whose trigeminal neuralgia symptoms fail to respond to any medicines may need to be considered for any of the following procedures. The aim of these procedures is to deliberately damage the trigeminal nerve to stop it transmitting pain signals to the brain:
Is Surgery a Legitimate Trigeminal Neuralgia Treatment?Does surgery help? People with trigeminal neuralgia symptoms who seem to have the nerve compressed by a loop of the superior cerebellar artery can finally get relief from an operation called microvascular decompression. This is an open surgical procedure requiring removal of a piece of bone (craniotomy) to get access to the trigeminal nerve. A small piece of teflon is placed between the nerve and artery. Whether it is the teflon, or whether it is the process of manipulating the trigeminal nerve that causes relief is a bit controversial. After the nerve has been decompressed, the bone from the craniotomy is replaced. There is no doubt that many patients will get final and lasting relief following microvascular decomperssion - but this procedure, because of the risks of having open neurosurgery, is definitely a last resort.Microvascular surgical decompression for neuralgia was pioneered by Iannetta, who published outcomes from over 4400 procedures back in 1998 (free full text). Gamma-Knife Surgery is a relatively new technique which targets small amounts of radiation (radiotherapy) to the contact point between the trigeminal nerve and artery. The Lahey Clinic, Massachussets, has a nice summary of abstracts on gamma knife surgery for trigeminal neuralgia.
The British Medical Journal published a full text review (Bennetto 2007). Resources for people with Trigeminal Neuralgia include the Information Sheet by the American Academy of Neurology. A personal account of Trigeminal Neuralgia, "Pained Life" by Carol Jay Levy will give a lot of insight into someones personal struggle with neuralgia.
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