Imagine feeling a brutal, knife-sharp pain whenever you did something simple
with your face, such as take a sip of water, touch your cheek or smile.
What you are imagining is reality for the 150,000 people in the United
States who are diagnosed with trigeminal neuralgia.
“This disorder, also called tic douloureux, is named after the trigeminal
Giac Consiglieri, MD, a neurosurgeon at
Annadel Medical Group. “This nerve has three branches that send signals from the upper,
middle and lower parts of the face to the brain. Trigeminal neuralgia
usually occurs from pressure put on the nerve by a blood vessel that’s
touching it, although it can also be a result of multiple sclerosis, which
damages the protective covering of the nerve; an injury to the nerve,
such as through trauma or surgery; or, in rare cases, a tumor.
Dr. Consiglieri adds that in classic cases of trigeminal neuralgia the
pain is sharp and intense, while atypical cases usually result in more
of a constant ache. For both types of trigeminal neuralgia, the pain is
generally felt in the mouth, cheek and jaw areas, and only on one side
of the face. It is more common for women than men, and people older than
50 are more likely to suffer from it than other age groups.
“This is a degenerative condition—there are intense periods
of short attacks, and periods where no pain is felt at all,” says
Dr. Consiglieri. “Over time, those attacks can strike more frequently
and last longer, and the amount of time patients are free of pain decreases.
This can be a debilitating problem that disrupts a patient’s daily
There are treatment options available to lessen the severity of trigeminal
neuralgia. First, a doctor will conduct a thorough examination, which
can include a neurological exam, a magnetic resonance imaging (MRI) test
and questions about when the pain started, what it feels like and what
triggered the attacks.
“Once a doctor makes the diagnosis of trigeminal neuralgia, there
are a couple of options,” says Dr. Consiglieri. “The first
is medication that blocks the nerve from sending the pain signals to the
brain. This can be done with certain anti-convulsants or muscle relaxers.
However, there can be side effects in some cases—which can result
in fatigue or dizziness, among other problems—and in other cases,
the efficacy of the medication wears off with long-term use.”
The other option is brain surgery. Some procedures are done on an outpatient
basis and others may require a hospital stay. "During the surgical
procedure called microvascular decompression, a small piece of material
is placed between the trigeminal nerve and the compressive blood vessels
adjacent to it to alleviate pain. That's the gold standard of treatment
if medication doesn't work," Dr. Consiglieri says. “There
are a range of other, less-invasive procedures for those patients who
are poor surgical candidates. All treatment options have their own risks
and benefits, so the decision should be tailored to each individual patient."
“It’s important that anyone suffering from trigeminal neuralgia
has a strong support network,” Dr. Consiglieri adds. “That
can include friends and family who help out with daily chores when the
pain is too much for the patient, as well as a trained counselor if there
are mental or emotional repercussions from the disorder.”
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