Trigeminal neuralgia

Discussion in 'Dental Medicine' started by Dr. Fazila rasheed, Aug 18, 2020.

  1. Dr. Fazila rasheed

    Dr. Fazila rasheed Active member

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    Trigeminal neuralgia is sudden, severe facial pain. It's often described as a sharp shooting pain or like having an electric shock in the jaw, teeth or gums.

    It usually happens in short, unpredictable attacks that can last from a few seconds to about 2 minutes. The attacks stop as suddenly as they start.

    In most cases, trigeminal neuralgia affects just one side of the face, with the pain usually felt in the lower part of the face. Very occasionally the pain can affect both sides of the face, although not usually at the same time.

    People with the condition may experience attacks of pain regularly for days, weeks or months at a time. In severe cases attacks may happen hundreds of times a day.

    It's possible for the pain to improve or even disappear altogether for several months or years at a time (remission), although these periods tend to get shorter with time.

    Some people may then develop a more continuous aching, throbbing or burning sensation, sometimes accompanied by the sharp attacks.

    Living with trigeminal neuralgia can be very difficult. It can have a significant impact on a person's quality of life, resulting in problems such as weight loss, isolation and depression.

    What causes trigeminal neuralgia?
    Trigeminal neuralgia is usually caused by compression of the trigeminal nerve. This is the nerve inside the skull that transmits sensations of pain and touch from your face, teeth and mouth to your brain.

    The compression of the trigeminal nerve is usually caused by a nearby blood vessel pressing on part of the nerve inside the skull.

    Trigeminal neuralgia can also happen when the trigeminal nerve is damaged by another medical condition, such as multiple sclerosis (MS) or a tumour.

    The attacks of pain are usually brought on by activities that involve lightly touching the face, such as washing, eating and brushing the teeth, but they can also be triggered by wind – even a slight breeze or air conditioning – or movement of the face or head. Sometimes the pain can happen without a trigger.

    Treating trigeminal neuralgia
    Trigeminal neuralgia is usually a long-term condition and the periods of remission often get shorter over time. However, the treatments available do help most cases to some degree.

    An anticonvulsant medicine called carbamazepine, which is often used to treat epilepsy, is the first treatment usually recommended to treat trigeminal neuralgia. Carbamazepine can relieve nerve pain by slowing down electrical impulses in the nerves and reducing their ability to transmit pain messages.

    Carbamazepine needs to be taken several times a day to be effective, with the dose gradually increased over the course of a few days or weeks so high enough levels of the medicine can build up in your bloodstream.

    Unless your pain becomes much better, or disappears, the medicine is usually continued for as long as necessary, which could be for many years.

    If you're entering a period of remission, where your pain goes away, stopping carbamazepine should always be done slowly, over days or weeks, unless a doctor tells you otherwise.

    If this medicine does not help you, causes too many side effects, or you're unable to take it, you may be referred to a specialist to discuss alternative medicines or surgical procedures that may help.

    There are a number of minor surgical procedures that can be used to treat trigeminal neuralgia – usually by damaging the nerve to stop it sending pain signals – but these are generally only effective for a few years.

    Alternatively, your specialist may recommend having surgery to open your skull and move any blood vessels that are compressing the trigeminal nerve. Research suggests this operation offers the best results for long-term pain relief, but it's a major operation and carries a risk of potentially serious complications, such as hearing loss, facial numbness or, very rarely, a stroke.

    Avoiding triggers
    The painful attacks of trigeminal neuralgia can sometimes be brought on, or made worse, by certain triggers, so it may help to avoid these triggers if possible.

    For example, if your pain is triggered by wind, it may help to wear a scarf wrapped around your face in windy weather. A transparent dome-shaped umbrella can also protect your face from the weather.

    If your pain is triggered by a draught in a room, avoid sitting near open windows or the source of air conditioning.

    Avoid hot, spicy or cold food or drink if these seem to trigger your pain. Using a straw to drink warm or cold drinks may also help prevent the liquid coming into contact with painful areas of your mouth.

    It's important to eat nourishing meals, so consider eating mushy foods or liquidising your meals if you're having difficulty chewing.

    Certain foods seem to trigger attacks in some people, so you may want to consider avoiding things such as caffeine, citrus fruits and bananas.

    Medicine
    As painkillers like paracetamol are not effective in treating trigeminal neuralgia, you'll usually be prescribed an anticonvulsant – a type of medicine used to treat epilepsy – to help control your pain.

    Anticonvulsants were not originally designed to treat pain, but they can help to relieve nerve pain by slowing down electrical impulses in the nerves and reducing their ability to send pain messages.

    They need to be taken regularly, not just when the pain attacks happen, but you can stop taking them if the episodes of pain cease and you're in remission.

    Unless a GP or specialist tells you to take your medicine in a different way, it's important to increase your dosage slowly. If the pain goes into remission, you can gradually reduce the dosage over the course of a few weeks. Taking too much too soon, or stopping the medicine too quickly can cause serious problems.

    At the start, the GP will probably prescribe a type of anticonvulsant called carbamazepine, although a number of alternative anticonvulsants are available if this is ineffective or unsuitable.

    Carbamazepine
    The anticonvulsant carbamazepine is currently the only medicine licensed to treat trigeminal neuralgia in the UK. It can be very effective initially, but may become less effective over time.

    You'll usually need to take carbamazepine at a low dose once or twice a day, with the dose being gradually increased and taken up to 4 times a day until it provides satisfactory pain relief.

    Carbamazepine often causes side effects, which may make it difficult for some people to take.

    These include:

    • tiredness and sleepiness
    • dizziness (lightheadedness)
    • difficulty concentrating and memory problems
    • confusion
    • feeling unsteady on your feet
    • feeling and being sick
    • double vision
    • a reduced number of infection-fighting white blood cells (leukopenia)
    • allergic skin reactions, such as hives (urticaria)
    You should speak to a GP if you experience any persistent or troublesome side effects while taking carbamazepine, particularly allergic skin reactions, as these could be dangerous.

    Carbamazepine has also been linked to a number of less common but more serious side effects, including thoughts of self-harm or suicide.
     

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