What is Trigeminal Neuralgia?

Trigeminal neuralgia is a relatively rare neurological disorder characterized by ultra-short, extremely painful, one-sided thrusts localized in one or more of the three branches of the facial sensory nerve.

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Facts about trigeminal neuralgia

In Denmark, between 200 and 250 people are diagnosed each year with trigeminal neuralgia. There are between 5,000 and 10,000 people living with the disease at home. Trigeminal neuralgia occurs slightly more frequently in women than men and typically debuts around the age of 50. However, it can also occur in adolescents.

The pain sensations are described as extremely severe and can occur when the insulating fat layer around a nerve root is gone, resulting in a “short circuit between the nerves”. The trigeminal nerve originates deep within the brain and branches beyond the eye, across the cheek, toward the nose, and into the lower jaw.

Trigeminal neuralgia cannot be diagnosed with blood tests, but an MRI scan is often necessary. For example, an MRI scan can show whether there is a so-called neurovascular contact, i.e. a blood vessel that presses on a nerve in the brain or whether there are other causes of the pain. If you have symptoms and there is a pinching of the nerve, it is called classic trigeminal neuralgia. An MRI scan will also be able to detect or exclude the presence of so-called symptomatic trigeminal neuralgia, i.e. that the trigeminal pain is a symptom of, for example, multiple sclerosis or a brain tumour.

In several cases, there is not an obvious cause or explanation for the trigeminal pain. This is called idiopathic trigeminal neuralgia.

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Symptoms of trigeminal neuralgia

• Hyperintense sting or twinge of seconds duration, localized in one half of the face in one or more of the three nerve branches of the face.
• Pain sensations can come without warning, but many people find that they are triggered by non-painful stimuli such as wind, cold, light touch such as shaving, brushing teeth, eating or just talking.
• Approximately 50% experience a more constant murmuring background pain in between pain hunches.

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Treatment options for trigeminal neuralgia

• There are different types of epilepsy medications that can be effective against trigeminal pain. Sometimes you have to combine several preparations to get the best possible effect. It is individual which preparation and what dose to take.
• Carbamazepine or Oxcarbazepine will be first choice. To this, if necessary, Gabapentin, Pregabalin or Lamotrigine can be added.
• Botox treatment may be an option.
• Operative interventions such as Glycerol Blockade, Balloon Compression or Microvascular Decompression may occur in the approximately 30% where medical treatment is not effective or tolerated. This is done via a referral to the Danish Headache Center.
• There is usually no effect of painkillers such as panodil, ipren or morphine.

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Preventive treatment for trigeminal neuralgia

Preventive medical treatment is used during periods of pain to eliminate or reduce symptoms. The medication can often be scaled down or completely removed for shorter or longer periods when you have been completely painless for at least 14 days.

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Can lifestyle changes help with trigeminal neuralgia?

There is no evidence that lifestyle changes have an effect on trigeminal neuralgia.

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It is important to have an accurate diagnosis and an appropriate treatment plan

Trigeminal neuralgia can have a significant negative impact on quality of life. Understanding both symptoms and treatment options is essential in order to manage the condition effectively. It is important to seek the help of a healthcare professional to get an accurate diagnosis and get a tailored treatment plan.

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Sources:

1. Health.com
2. KnowledgeHeadache.dk

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