Trigeminal Neuralgia: The Most Excruciating Pain
Trigeminal neuralgia (also known as tic delaroux) is a disorder characterized by a severe, electrical shooting pain in the face. The trigger area on the face is typical around the nose or upper lip. Affected individuals experience a brief but intense electrical or burning pain on the affected side of their face. Trigeminal neuralgia typical affects only one side of the face. The cause of this disorder is unknown in most cases and it is not hereditary. On rare instances, there can blood vessels pushing up against the nerve. Patients with trigeminal neuralgia find that air blowing across their face, brushing their teeth, chewing, washing their face, putting on make up or drinking hot/cold beverage will trigger severe pain attacks. At times, talking can even trigger pain episodes. They can have trouble sleeping at night if they lay on the affected side. Although the majority of individuals with this condition are over the age of 50, it can begin at younger ages. Patients may have daily face pain attacks for weeks to months and then the condition will suddenly go into remission for a period of time. This remission period may last weeks to months but then reoccurs as severe as ever. Other less fortunate individuals have the pain continually.
Fortunately good non-narcotic medical treatment exists to control pain. The main medication used is an antiseizure medication called carbamazepine (Tegretol.) This medication is considered by many to be the drug of choice for treatment of this condition. Tegretol frequently provides excellent, prompt relief and control of facial pain. For patients who cannot tolerate Tegretol, or for those who do not respond, there are severe other antiseizure medications that can be helpful. These include Trileptal, Topamax, Lamictal, Neurontin and Lyrica. Another medication, which is not in the antiseizure class, is amitriptyline. It is important to note that narcotic pain killers do not work well for trigeminal neuralgia and should be avoided.
For patients with intractable trigeminal neuralgia that does not respond to the typically used medications, surgery may be an option for treatment. There are severe surgical procedures that can be effective. Radiofrequency rhizotomy is a commonly performed procedure that provides good pain relief for many patients. It is not an invasive procedure which increases the safety. Glycerol (alcohol) rhizotomy is a similar procedure that can be tried. Gamma knife surgery procedure is a noninvasive treatment using focused radio waves to ablate the nerves responsible for pain. These are the more common surgical procedures used to treat trigeminal neuralgia but should be reserved only for those patients who have not responded to several different medication trials.
For diagnosis, it is necessary to see a neurologist familiar with this condition. Patients all too frequently go to a dentist, thinking they have some type of dental problem. I have seen patients who have had multiple teeth taken out as well as root canals and yet their pain persists. This is because trigeminal neuralgia is not a dental problem. Do not suffer unnecessarily, get into to see a physician who can help.