Special Diagnostic Methods, Special Treatments for Trigeminal Neuralgia

Christina Lasich, MD Health Pro August 22, 2011
  • The number five may be your unlucky number if you have Trigeminal Neuralgia. This type of neuropathy effects the fifth cranial nerve (CN V) called the Trigeminal Nerve. Those who have Trigeminal Neuralgia experience a wicked facial pain that may not respond to ordinary treatment used in other types of nerve pain. Trigeminal Neuralgia is a special type of nerve pain and thus needs special considerations in order to be tamed.  

     

    Originating from deep in the brain in an area called the pons, the Trigeminal Nerve (CN V) supplies both motor and sensory function to the face and head. Any three of the sensory branches can be a source of pain. Neuralgia affecting the V1 branch is felt primarily in the forehead. V2 neuralgia is felt in the cheek and upper lip/jaw. And V3 neuralgia is felt in the lower jaw, mouth, and side of the head. As a rule, the attacks of pain are usually lancinating , unilateral and triggered by something like teeth clinching. Sometimes Trigeminal Neuralgia follows its own special rules and becomes an atypical, constant pain.

     

    A careful diagnosis is the rule for Trigeminal Neuralgia because this nerve travels through some sensitive areas. Bad things like stokes and tumors deep in the brain need to be ruled out. Multiple sclerosis should also be ruled out. Upper cervical dysfunction from trauma or fractures should also be considered because some of the sensory fibers from CN V come from as low as the second cervical nerve. Sometimes this cranial nerve can be compressed by the Superior Cerebellar Artery.  And sometimes this nerve is a victim of post-herpatic neuralgia. All of these possibilities should be considered before labeling the problem as Idiopathic Trigeminal Neuralgia.

     

    Magnetic Imaging is the rule when investigating problem with a cranial nerve. Specifically, a thin cut neurography with 3-D reconstruction would be the best way to make sure that something is not pressing on the Trigeminal Nerve. If something were mechanically pressing on this cranial nerve, a neurosurgeon can potentially cure the problem. Otherwise, other special treatments need to be considered.

     

    Because Trigeminal Neuralgia is a type of nerve pain, many try to treat it with typical nerve pain treatments. However, neuralgia involving the fifth cranial nerve typically does not respond to anti-depressants like amitriptyline (Elavil) or duloxetine (Cymbalta).  As a rule, anti-epileptic medication should be the first choice for treating Trigeminal Neuralgia. For some reason, the blockade of sodium and calcium channels is extremely important if you want some relief from the frequent attacks of facial pain. Of the anti-epileptics both carbamazepine (Tegretol) and oxcarbazepine (Trileptal) are favored, but not without side effects. Another medication considered very useful for treating Trigeminal Neuralgia is lamotrigine (Lamictal) which may be more effective for Trigeminal Neuralgia than Lamictal is for Diabetic Peripheral Neuropathy. And finally, if you do not mind a few memory problems, topiramate (Topomax) is an option. Trigeminal Neuralgia is not easy to treat, but with some trial and error upwards of 80% of patients will respond to one of these four medications: Tegretol, Trileptal, Topomax and Lamictal.

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    Any the unlucky event that medications are not relieving the pain, some more drastic measures may be needed like Trigeminal Nerve stimulation or even motor cortex (brain) stimulation. But if some special rules are followed, it is unlikely you will need some drastic alternatives. The diagnosis of Trigeminal Neuralgia needs to be as precise as possible for uncovering the cause in the event that a surgery could remedy the problem. Some special medications used to treat seizures need to be initiated as early as possible once the diagnosis is made. With just these two rules of diagnosis and treatment, Trigeminal Neuralgia can be tamed.