Detailed Trigeminal Neuralgia info

TN imageTypes

° Typical TN

° Atypical TN

° Pre-TN

° Multiple-sclerosis-related TN

° Secondary TN

° Post-traumatic TN (trigeminal neuropathy)

° Failed TN

Causes

° Trigeminal nerve misfiring, sending out wrong pain signals

° Pressure from blood vessels in the head

° Pressure from a tumor or cyst

° Injury to the nerve from head trauma, surgery, or a stroke

Symptoms

° Severe episodes of searing, shooting, jabbing pain that feel like electric shocks

° Sudden attacks of pain which are triggered by noise, lights, touching the face, chewing, speaking or brushing teeth

° Spasms of pain which last from a couple of seconds to a couple of minutes

° Episodes of cluster attacks which may go on for days, weeks, months, and in some cases longer

° There may be periods without any pain

° Pain wherever the trigeminal nerve and its branches may reach, including the forehead, eyes, lips, gums, teeth, jaw and cheek

° Pain which affects one side of the face

° Pain on both sides of the face (much less common)

° Pain that is focused in one spot or spreads in a wider pattern

° Attacks of pain which occur more regularly and intensely over time

° Tingling or numbness in the face before pain develops

Triggers

° Noise or lights

° Eating or drinking

° Smiling, yawning, or talking

° Shaving or washing your face

° Putting on makeup or combing your hair

° Wind or temperature changes

° Cold air touching the face

° Brushing teeth

TN image faceWhere

° Extending as far as the ear, and often mistaken for the pain of an ear infection

° The ophthalmic branch (V1) is responsible for sensation from the scalp, forehead, upper eyelid and tip of the nose

° The maxillary branch (V2) sensation covers the lower eyelid, the side of the nose, the upper lip and cheek, and the upper teeth and gums

° The mandibular branch (V3) is responsible for sensation of the lower teeth and gums, lower lip, chin, jaw, and part of the ear. It is also responsible for supplying the muscles involved with chewing (mastication), those muscles involved with chewing

What

° Also called tic doloureux, French for “painful twitch”, is sadly also called ‘The suicide disease’

° Usually the most intense pain is short-lived (from a few seconds to up to two minutes), but can result in a more constant burning or aching

° Given the location and nature of the pain associated with trigeminal neuralgia, it is often mistaken for dental pain

Diagnosis

The International Headache Society has established criteria for making the diagnosis and includes the following:

° Paroxysmal attacks of pain lasting from a fraction of a second to 2 minutes, affecting 1 or more divisions of the trigeminal nerve and fulfilling criteria B and C.

° Pain has at least one of the following characteristics: (1) intense, sharp, superficial or stabbing; or (2) precipitated from trigger areas or by trigger factors

° Attacks stereotyped in the individual patient

° No clinically evident neurological deficit

° Not attributed to another disorder

Treatment

° Carbamazepine (Tegretol®)

° Trileptal (Oxycarbazepine)

° Phenytoin (Dilantin®)

° Baclophen (Lioresal®)

° Gabapentin (Neurontin®)

° Pregabalin (Lyrica)

° Anticonvulsants: These control seizures, help prevent pain attacks, and decrease symptoms

° Antidepressants: These decrease pain and help prevent depression

° Muscle relaxers: When your facial muscles are relaxed, you may be less likely to have pain attacks

° Pain medicines: You may be given pain medicines if your facial pain is severe

TN TreatmentProcedures

° Nerve block: This is an injection of medicine that makes you lose feeling in an area of your body. You may need a nerve block if your pain is not going away, or is getting worse. A nerve block may also be used to make you lose feeling in an area before a procedure is done

° Microvascular decompression: This is surgery to separate your trigeminal nerve from the blood vessel pressing on it

° Percutaneous procedures: These procedures help control your pain by destroying an area deep in your skull where nerve branches come together. Caregivers will insert a needle and tube through the base of your skull to reach this area

° Peripheral techniques: Peripheral techniques are done to block the nerve impulses that cause your pain attacks. Your caregiver may destroy the nerve with alcohol (medicine) injections, or he may freeze the nerve. He may also use surgery to remove part of the nerve.

° Stereotactic radiosurgery: This is also called Gamma Knife surgery. Radiation beams are used to remove a blood vessel that is pressing on the nerve. You may have some pain relief right away after radiosurgery. It may take at least 1 month before you have decreased pain

Link to MS

° Damage from other diseases, such as multiple sclerosis (MS)

° Trigeminal neuralgia tends to be one of the first symptoms of multiple sclerosis for those who experience it

° Perhaps the most intensely painful MS-related symptom

° Only 4% of people with MS experiencing this kind of pain

Resources

http://www.tna.org.uk/index.php

http://fpa-support.org/

http://www.ninds.nih.gov/disorders/trigeminal_neuralgia/detail_trigeminal_neuralgia.htm

http://www.neuros.net/en/trigeminal_neuralgia.php

News stories

http://www.independent.ie/life/health-wellbeing/landmarks-set-to-light-up-for-trigeminal-neuralgia-30635571.html

http://www.independent.ie/life/health-wellbeing/health-features/tn-the-disorder-that-sends-a-shocklike-pain-along-the-nerve-30372993.html

http://www.guardian-series.co.uk/news/11470653.Woman_who_overcame__suicide_disease__has_released_her_first_book/

http://www.bbc.com/news/uk-wales-23181650

http://www.miamiherald.com/news/local/community/miami-dade/article18579842.html

http://abc30.com/health/teen-with-suicide-disease-has-life-back-after-surgery/538855/

©WVE and Ireland, Multiple Sclerosis & Me, 2011-2015. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Willeke Van Eeckhoutte and Ireland, Multiple Sclerosis & Me with appropriate and specific direction to the original content.

2 thoughts on “Detailed Trigeminal Neuralgia info

  1. Thanks yet again for more insight into how this amazing machine of ours works, particularly the small details that have such impact. . I find it extremely interesting. I always look forward to your blog.

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