Trigeminal Neuralgia Symptoms: Trigeminal Neuralgia Treatment

Trigeminal neuralgia symptoms also called tic douloureux, can occur suddenly and be disabling. It is a condition that affects the trigeminal nerve (the 5th cranial nerve), one of the largest nerves in the head.

What is neuralgia? Simply.. a nerve in pain.

The trigeminal nerve is responsible for sending impulses of touch, pain, pressure, and temperature to the brain from the face, jaw, gums, forehead, and around the eyes.

This type of headache is characterized by a sudden, severe, electric shock-like or stabbing pain typically felt on one side of the jaw or cheek.

It usually attacks women more than in men and rarely affects anyone younger than 50.

Causes of trigeminal neuralgia include dental work or having a virus. Sometimes the cause is unknown. recurring headache

Trigeminal neuralgia symptoms include attacks of pain, which generally last several seconds and may be repeated one after the other, may be triggered by talking, brushing teeth, touching the face, chewing, swallowing and even cold air brushing the face. At times the pain can refer to other nerves in the face and jaw. Many people complain of pain behind the ear.

It may come and go throughout the day and last for days, weeks, or months at a time, and then disappear for months or years.

Some patients may have an atypical form of the neuralgia in that the pain is constant. These patients may be good candidates for surgery (see below).

Trigeminal Neuralgia Treatment

Treatment of this type of head pain usually starts with a daily course of anti-seizure drugs that have been shown to be very effective in this condition.

Unlike migraine, this neuralgia does NOT respond to the drugs typically used for migraines.

The most commonly used drugs are:

  • Neurontin (gabapentin)
  • Trileptal (oxcarbazepine)
  • and the newer drugs Lyrica(pregabalin)and Lamictal (lamotragine)

All of these medications for trigeminal neuralgia symptoms can be very effective, but treatment is dose dependent. Generally we raise the dosing every 2-3 weeks until the person responds. An initial response of less pain and less frequency of pain is a good sign and means the dose should be increased.

Klonopin has been shown in some cases to be effective, but I have not seen this to be as effective as the other medications.

Side effects of Neurontin and Trileptal included drowsiness, dizziness and numbness and tingling. Lyrica can cause dizziness, weight gain and swelling in the extremeties. Lamictal can cause dizziness and weight gain.

For the most part, studies have shown that steriods and opiods are not effective in treating trigeminal neuralgia symptoms. Clinically, I have found that if IV steroids are given with in 48 hours of the pain starting, then they are effective. If several weeks have gone by then they generally are not too effective.

Surgical Options

Sometimes trigeminal neuralgia symptoms fail to respond to medications despite increasing doses and/or changing medications. In this case gamma knife surgery may be an excellent option. This is a type of radiation that is narrowly targeted to the nerve root to stop the pain.

Although called 'surgery" it is actually radiation and the machine used looks somewhat like a CT scanner.

Gamma knife for trigeminal neuralgia

Most studies about gamma knife radiosurgery have shown that 80-90% of patients have pain relief in 3-4 weeks after surgery. A very small percentage of patients have no relief from gamma knife surgery and may have to have open surgery. If this is needed, the complications of surgery apply which are 1-2% risk of infection and rarely stroke. Stroke risk is usually determined by other factors such as hypertension, high cholesterol and obesity.

Lack of response to medication may be especially true if the nerve is in contact with a small blood vessel. If this is the case, the constant irritation of the nerve can only be relieved by surgery.

Here, a different type of surgery is performed as a small piece of Teflon is inserted between the nerve and the offending vessel (usually a tiny artery). This surgery is an open procedure unlike the gamma knife.

Doesn't sound like your headaches? Try reading more about other recurring headaches.

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