Trigeminal Neuralgia
About Trigeminal Neuralgia
Trigeminal Neuralgia is a condition defined by intense persistent facial pain that disrupts normal daily activities. These painful episodes are rather short-lived but the pain can return sporadically. Those sharp bursts of pain flare can be so intense and severe that it incapacitates one’s activities of daily living, rendering one living in fear, anticipating the next attack. Some may experience constant pain but not as severe.
There are two types of trigeminal neuralgia: Typical (Type 1) and Atypical (Type 2). For typical trigeminal neuralgia, a person will experience painful episodes that are sharp, intense, and sporadic. There will be electric current pain and/or a burning sensation over your face (either over the cheek including the side of the nose, lower jaw or eyebrow) that can last anywhere from a few seconds to minutes. On the other hand, atypical trigeminal neuralgia will be less painful but widespread. The pain will likely be constant, with stabbing or burning sensations, as well as persistent aches and pains.
What Causes Trigeminal Neuralgia?
The face is densely packed with many structures passing through each location. It is often postulated that blood vessels (cerebellar/carotid artery) touch the trigeminal nerve due to various factors, causing the patient to feel pain.
Based on medical research, 90% of the cases present no mechanical cause for trigeminal neuralgia, rather it is caused by a compression of arteries or veins.
Some possible causes of Trigeminal Neuralgia are as follows:
- Nerve sensitivity syndrome
- Close proximity of blood vessel
- Facial vascular deformity
- Brain tumour
- Scarring and fibrosis
- Infection
What Causes Trigeminal Neuralgia?
The face is densely packed with many structures passing through each location. It is often postulated that blood vessels (cerebellar/carotid artery) touch the trigeminal nerve due to various factors, causing the patient to feel pain.
Based on medical research, 90% of the cases present no mechanical cause for trigeminal neuralgia, rather it is caused by a compression of arteries or veins.
Some possible causes of Trigeminal Neuralgia are as follows:
- Nerve sensitivity syndrome
- Close proximity of blood vessel
- Facial vascular deformity
- Brain tumour
- Scarring and fibrosis
- Infection
Symptoms Of Trigeminal Neuralgia
Sharp pain
The pain from Trigeminal Neuralgia is felt around the face, radiating into three broad areas: the jawbone, the cheekbone, and the eye socket. When it attacks, it feels like an electric shock, making it impossible to move the jaw or touch the area.
You may initially experience short mild attacks, with periods of remission. But Trigeminal Neuralgia can progress, causing longer, frequent attacks of searing intense pain.
The pain is also described as pulsating and episodic or chronic gnawing pain. In cases involving the eye, it is often associated with involuntary tearing and eye congestion.
Numbness
Triggering factors
Common daily activities may trigger your pain, this includes activities such as washing your face, brushing your teeth, talking or a light breeze. Opening and closing your mouth can trigger a pain attack. The pain may also impede your ability to eat and drink, some people risk dehydration and weight loss because of this condition.
When Should I Seek Medical Attention?
You should seek medical help if you’re experiencing any of the following:
- Sharp stabbing pain inside the face, cheek, or chin area
- Pain resembling toothaches that shoot into the face
- Chronic gnawing pain
- Pulsating and episodic pain
A Message About Trigeminal Neuralgia
Although trigeminal neuralgia is not life-threatening, it can have life-altering effects. Trigeminal Neuralgia pain has been described as the “mother of all pain”, causing a severely intense distressing pain score of 10/10. It has prompted many to seek dentists to remove their “toothache” thinking it was caused by dental causes. There is no resolution from dental extraction, as its cause is nerve hypersensitivity arising from the 5th nerve of the face.
Strong painkillers do not provide pain relief as they are of a different nature of pain. Most painkillers address inflammation and this condition is not a trauma or wear and tear condition. It is a nerve type of pain that will respond only to nerve stabilisers.
About 20% of patients will need laser injection treatment of desensitization of painful nerves to abort the painful attacks. This minimally invasive approach to stopping the nerve pain is highly effective and relatively safe (done as day surgery).
You can, however, live a relatively pain-free life with various treatment options. This is a condition that will likely be present for the rest of your life in some form or another. After a laser injection procedure, there is a 25% chance of recurrence, as the underlying nerve gets re-sensitized again over time.
Diagnosing Trigeminal Neuralgia
Here at Singapore Paincare, our team of experienced primary care and pain care specialists together with a neurologist will conduct a thorough diagnosis. This includes a physical exam, questions about your symptoms and an evaluation of your medical history. X-rays and/or MRI scans may also be used to investigate the causes of your Trigeminal Neuralgia.
What Treatments Are Available for Trigeminal Neuralgia?
Trigeminal Neuralgia is extremely intolerable. While this condition is notoriously difficult to treat, our expertise in minimally invasive options is meant to provide maximum pain relief and cure. Our goal at Singapore Paincare is to treat your pain with the least invasive option after accurately identifying the cause of your pain. Our approach to pain resolution focuses on the removal of pain generators via specialised injection and minimally invasive procedures. Combined with pharmacological treatments and cognitive and physical rehabilitative therapies, we help patients improve functions and prevent pain from recurring.
Non-Surgical Treatment for Trigeminal Neuralgia
Anti-convulsant
Our doctors may prescribe medications to reduce the pain and relieve trigeminal neuralgia.
Anti-Depressants
Anti-depressants help to cope with the effects of pain from the condition which have shown effective results in many patients.
Myospan Injections
Our specialists offer nerve block injections, this is done to reduce the need for a long course of drug therapy, the immediate pain relief can last for a few weeks to months.
Minimally Invasive Treatment Options for Trigeminal Neuralgia
Percutaneous Needle Surgery
Treatment includes applying different modalities through the needle to desensitise the painful nerve. After the operation, you can go home the same day. Percutaneous needle surgery is simple, has little downtime, minimal wound (pinhole), and is safe. Specific techniques or procedures are trigeminal ganglion radiofrequency ablation, balloon compression or glycerine injection.
- Trigeminal Ganglion Radiofrequency Ablation directly applies laser heat to shock and block the painful nerve. It is the most considered option because of its low risk and high yield. We use a laser injection to “burn” and desensitise the trigeminal nerve. It is not to kill the nerve nor to cut the painful nerve away. It aims to “set” the nerve and make the nerve less sensitive. Over time, the nerve becomes less sensitive and functions normally, preventing recurrence. In a rare situation or about 1% of the cases, may face complications from the laser injection. Laser injection treatment while effective for treating trigeminal neuralgia is not guaranteed to heal trigeminal nerve problems. It can reduce the pain by 70 – 100%. There is a 10% chance of no results even in the most skilled hands. In post-treatment follow-up of 5 years, there is a 25% chance of recurrence. Hence patients are given medications to prevent the recurrence of nerve hypersensitivity.
- Balloon Compression is a tiny balloon inserted along a thin tube inserted into the cheek, inflated and dilated to squeeze the nerve, and then removed.
- Glycerine is injected around the semilunar ganglion, where the three main branches of the trigeminal nerve are connected. The injection will “freeze” the nerves and stop the transmission of pain.
Stereotactic radiosurgery / Radio Therapy
Stereotactic radiosurgery (also known as gamma knife) is a fairly new treatment that uses a focused beam of emitted radiotherapy light to enter the brainstem and deliberately damage the trigeminal nerve. This process may be repeated 1- 8 times over a few weeks. Though it may take months to produce results, pain relief can last months to years.
The most common complication of this launch procedure is facial paralysis and difficulty opening the affected side of the mouth. In some cases, complications may include scarring and hyperpigmentation, can be persistent and can be quite cumbersome.
Surgical Treatments for Trigeminal Neuralgia
Non-surgical methods are the recommended approach to Trigeminal Neuralgia. However, if the pain is long-lasting and does not improve, our doctors may recommend surgery. As surgery always comes with associated risks, complications and downtime – it may not be suitable for everyone. Surgery may not guarantee good outcomes too.
If you choose to have surgery, your options may include:
Microvascular Decompression
Microvascular decompression surgery is a major operation, powered by neurosurgery. The surgery is performed by moving a compressed artery away from the compressed root. However, access to the root is usually difficult.
At present, microvascular decompression surgery is the most effective treatment for trigeminal neuralgia. However, it is an invasive surgery and has the potential for serious complications such as facial paralysis, hearing loss, and stroke.
How Can I Prevent Trigeminal Neuralgia?
Sadly, this condition isn’t preventable. You may, however, avoid doing certain activities that cause intense pain.
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