Trigeminal Neuralgia: Characteristics And Treatment

Many people consider trigeminal neuralgia to be the most painful condition a person can experience. Sometimes it is even a direct cause of suicide. It comes from a disorder of a nerve in your brain that releases violent electric shocks in response to small, normal things: speech, eating, temperature changes…

It’s not just headaches or even migraines. People who are unlucky enough to live with trigeminal neuralgia also know that painkillers do not help. Much of the time, even morphine cannot relieve their pain.

When that happens , only antiepileptics can help them live a functional life. What they get in return is, of course, all the side effects that come with these drugs.

From the outside, their pain may seem excessive. It is not without reason that some people call it the suicidal disease. It was first classified in 1672, but there are examples of this disease that go back much further.

They describe it as one of the most crippling, intense forms of pain that anyone can go through. Today, they estimate that trigeminal neuralgias affect between 8 and 12% of all people. It may be a chronic disease, but there are still some treatments for it.

Trigeminal neuralgia involves extreme violent pain similar to electric shock. It can last as short as two seconds or up to two hours, and it can reappear in several episodes over the course of a few weeks, or even months.

What is trigeminal neuralgia?

The root of trigeminal neuralgia is in the fifth out of our twelve cranial nerves. It’s the biggest of all the nerves in our head. Now we look at its structure, to give you a better understanding of how it radiates all that pain:

• This nerve has three branches. The first is the ophthalmic or superior branch, which gives a painful sensation that can go from your scalp to one side of your forehead, along with the eye that is on the same side.
• The maxillary or middle branch stimulates your cheeks, upper jaw, upper lip, teeth, upper gums and one side of the nose.
• Finally, there is  the mandibular or inferior branch. This causes painful sensations in your lower jaw, teeth, lower lip and lower gums.

People with trigeminal neuralgia will generally experience pain in one side of their face. But there is also a rare condition called bilateral neuralgia that makes it worse. Basically, it means they have trigeminal neuralgia on both sides of their head.

What are the symptoms of trigeminal neuralgia?

The symptoms associated with trigeminal neuralgia vary between patients. One thing they all share is “trigger areas,” the regions that respond with intense pain when stimulated. The pain is like an intense electric shock that lasts seconds, minutes – up to two hours.

• Simple actions like touching or stroking your face can be painful.
• Changes in temperature, chewing, speech and grinding of your teeth can all trigger the crippling pain that comes with neuralgia.
• The pain follows a path that can go from your scalp to an eye, an ear and all the way down to your jaw.
• After this intense electric shock, people with this disease can usually do nothing for an hour or two. They will not be able to eat, drink or even open their eyes. They have to wait for the nerves to subside little by little.

Causes of trigeminal neuralgia

Trigeminal neuralgia does not have a single cause. The condition actually has a wide range of associated factors. We will look at some now, to better understand the complex reality behind this disease.

• In general, it is genetic.
• As MRI scans have shown, there is often a blood vessel that pushes the trigeminal nerve out of the brainstem. This compression then leads to deterioration of myelin, the protective layer of a nerve. This allows the large electric shocks to occur.
• In addition, we know that facial or oral surgery and strokes caused by traumatic injuries can cause it.
• It is also important to point out that the primary origin is often unknown. In other words, it is almost impossible to know what exactly caused them to develop the disease.

Can it be treated?

We should keep in mind that this neuropathic condition varies from person to person. There are people who experience it for two months in a row, but then it goes away for a while. Then there are people who go through it every day and people who have it on both sides. Some have managed to control their triggers and enjoy a better quality of life.

Therefore, a therapeutic approach must be adapted to each individual person. But let’s look at some of the most common strategies:

• Antiepileptic drugs are usually the most effective for the treatment of trigeminal neuralgia. Drugs such as carbamazepine, oxcarbazepine and gabapentin are the most common.
• Tricyclic antidepressants such as amitriptyline and nortriptyline are a common treatment for pain relief in this disease.

A last resort: surgery

When medication does not work, the only other option is surgery. Here are the different options patients have when it happens:

• Rhizotomy : Temporarily disrupts specific nerve tissues so they do not cause pain.

• Glycerol injection: an outpatient procedure involving the tissues around your trigeminal nerve. This treatment takes at least two years.
• Radiofrequency lesion: an outpatient procedure in which they use an electrode to damage the nerve tissue causing the pain. It is temporary, like rhizotomy.
• Microvascular decompression: The most invasive (and effective) of all surgeries. First, they make a small hole in the mastoid bone behind your ear. Then they use a small balloon to move the blood vessel that pushes against your trigeminal nerve away.

So as you can see, there are many different ways to deal with trigeminal neuralgia. It affects between 8 and 12% of the population , and we also know that about 70 to 80% of patients respond well to medication. This means that they never have to undergo surgery.