Trigeminal neuralgia is a chronic painful disease affecting the trigeminal nerve (one of the main craniofacial nerves). It is characterized by intense burning and stabbing pain in different areas of the face that appears at different times. There are two different types of trigeminal neuralgia, known as type 1 (TN1) and type 2 (TN2).
Steps
Method 1 of 2: Medications
Step 1. Consult your doctor about anticonvulsant medications
They are the most used to treat this disorder; Your doctor may prescribe one or more drugs in this category until you find the one that works best for managing your symptoms.
- These drugs are prescribed more often than traditional pain relievers (such as non-steroidal anti-inflammatories), as the latter are unable to block the erroneous electrical signals of the neurons that send the pain message.
- Carbamazepine is usually the anticonvulsant with which treatment is started.
- Oxcarbazepine is similar to carbamazepine in effectiveness but may be more expensive. Gabapentin and clonazepam are often used for patients who cannot tolerate carbamazepine.
- Baclofen could be a useful drug to be taken together with the anticonvulsant, especially for patients with TN associated with multiple sclerosis.
- These drugs can lose their effectiveness over time as they enter the blood system. At this point your doctor should change your prescription and point you to other different types of anticonvulsants, to which your body is not yet numb.
Step 2. Get a prescription for tricyclic antidepressants
These are usually given to manage symptoms of depression, but are also effective in treating chronic pain.
- These drugs have proved effective for the control of chronic painful pathologies, such as trigeminal neuralgia, thanks to their ability to regulate the absorption of neurotransmitters by damaged neurons.
- The dosage of tricyclic antidepressants for the management of chronic pain is lower than for the treatment of depression.
- Amitriptyline and nortriptyline are among the most commonly prescribed antidepressants to treat chronic pain.
Step 3. Avoid analgesics and opiate pain relievers
These types of medications are not very helpful in managing the pain of trigeminal neuralgia attacks, although some patients with TN2 type neuralgia seem to respond better.
- TN2 type disease consists of constant pain that can be relieved with these drugs as they are absorbed into the blood system, while TN1 type involves recurrent episodes of excruciating pain that do not subside by taking these medicines.
- Your doctor may prescribe opioid pain relievers and pain relievers such as levorphanol or methadone.
Step 4. Try antispasmodic agents
These are used to relieve the painful sensation caused by the attacks of trigeminal neuralgia. Sometimes they are given concomitantly with anticonvulsants.
- Antispasmodic drugs, also known as muscle relaxants, are prescribed because they inhibit the involuntary movements of the muscles, which can be triggered by nerves becoming "jammed" during an attack.
- Among the most used antispasmodics are Baclofen, Gablofen and Lioresal; they all contain baclofen as an active ingredient.
Step 5. Consider getting a botulinum toxin (Botox) injection
Your doctor may consider this procedure to manage trigeminal neuralgia if your body is unresponsive or has become numb to anticonvulsants, tricyclic antidepressants, or antispasmodics.
- Botox has been shown to be effective in managing pain in a high percentage of patients suffering from trigeminal neuralgia, especially those with rapid muscle contractions.
- Many people are quite reluctant to undergo botulinum toxin injections, due to the negative connotation due to its use in plastic surgery. However, you should not underestimate this type of treatment, because it can really be a valid remedy for managing chronic facial pain, when other methods have not been successful.
Step 6. Try alternative medicine
The effectiveness of these procedures on chronic neuralgia has not been verified with appropriate medical studies. However, many people have reported that the pain was partially relieved by techniques such as acupuncture, cervical chiropractic, and nutritional therapy.
Method 2 of 2: Surgery
Step 1. Learn about surgery
Trigeminal neuralgia is a progressive disease. Although some medications can help you manage symptoms, over time, in severe cases, the disorder can cause permanent damage to the trigeminal nerve, resulting in debilitating pain or even permanent numbness of the face.
- Your doctor will help you choose the surgical procedure that best suits your situation, based on your health and medical history. The severity of the problem, past episodes of neuropathies, and your overall health all affect the type of surgery that is right for you.
- The general purpose of surgery is to minimize damage to the trigeminal nerve as the disease progresses, and to improve quality of life when medications are no longer effective in managing pain.
Step 2. Try balloon compression
This surgical procedure aims to destroy the insulating sheath around the branches of the trigeminal nerve, so that pain impulses cannot be transmitted.
- During this surgery, a balloon is inserted through a catheter into the skull, which is inflated to damage the nerve sheath.
- This is a procedure performed on an outpatient basis under general anesthesia, although an overnight hospital stay is sometimes required.
- Typically, with this surgery, the pain is relieved for about two years.
- Many patients experience temporary numbness of the face or muscle weakness when chewing after undergoing this procedure, but they typically experience a sense of pain relief.
Step 3. Ask for more details about glycerol injections
This technique is done to treat disease when the third and lowest branch of the trigeminal nerve is affected.
- During this outpatient procedure, a fine needle is inserted through the cheek that reaches the base of the skull and the third branch of the trigeminal nerve.
- Once injected, glycerol damages the trigeminal nerve sheath and consequently relieves painful symptoms in the lower face.
- The effects of this procedure last for about one to two years.
Step 4. Try radiofrequency rhizolysis
This technique, also known as RF ablation, is practiced on a day hospital basis; the surgeon burns the nerve fibers with an electrode, desensitizing the painful areas.
- During the surgery, a needle with an electrode is inserted into the trigeminal nerve.
- When identifying the area of the nerve that is causing the pain, the surgeon sends short electrical pulses through the electrode to damage the nerve fibers and numb the area.
- In half of the patients, symptoms return 3-4 years after the procedure.
Step 5. Learn about stereotaxic radiosurgery (also called radiosurgery)
During an operation of this type, a computer is used that is able to send concentrated radiation to the suffering area of the trigeminal nerve.
- The radiation causes damage to the nerve, thus interrupting the transmission of painful signals that are sent to the brain. As a result, the patient finds relief from suffering.
- Most often, patients can leave the hospital the same day or the next.
- Most patients who undergo radiosurgery experience some relief after a few weeks or months, but the pain often recurs within 3 years.
Step 6. Try vascular microdecompression
This is the most invasive and risky procedure for trigeminal neuralgia. The surgeon makes a hole behind the ear and, using an endoscope, visualizes the trigeminal nerve. At this point, apply a tampon of synthetic material or muscle between the blood vessels and the nerve to compress the latter.
- Recovery times for this surgery vary from person to person and hospitalization is often required.
- This procedure is the most effective for trigeminal neuralgia, because about half of the patients do not relapse for 12-15 years.
Step 7. Learn about the neurectomy
During this procedure, part of the trigeminal nerve is removed. As this is invasive surgery, it is only offered in cases where the neuralgia progresses rapidly and severely.
- Neurectomy is often done when no blood vessel is found to compress during vascular microdecompression procedures.
- The surgeon removes several portions of the trigeminal branches to ensure pain relief.
Advice
- TN1 type neuralgia is the most common. It occurs as a sudden episode of excruciating pain that lasts from a few seconds to two minutes, but also up to two hours. Seizures are often confused with partial facial seizures, which are characterized by stabbing and burning pain.
- TN2 neuralgia is less common and is characterized by long and constant episodes of dull pain. Often, at first, it is confused with toothache, but the pain continues even after undergoing dental treatment.
- Attacks of TN2 type neuralgia can be triggered by simple actions, such as washing the face or a gentle vibration, all of which make managing them very difficult.
