Trigeminal Neuralgia: The suicide disease 

1-240x240 (1)What is trigeminal neuralgia?

Trigeminal Neuralgia is a type of facial pain / headache causing sharp, shooting pain on one side of the face. It is one of the most painful diseases known to mankind. It is also called ‘suicide disease’, because of the severity of the pain.

What are the symptoms of trigeminal neuralgia?
People suffering from trigeminal neuralgia usually have a sharp, shooting, electric shock like pain on one side of the face / head. Trigeminal nerves are basically a set of 3 nerves that provide sensation to either side of the face. Trigeminal pain can affect different parts of the face. Initially the sharp pain is occasional and very short lasting. Gradually the pain becomes more permanent. It is more common in elderly people, over the age of 50 years. It is slightly more common in women.

What triggers trigeminal pain attacks?
Trigeminal neuralgia pain can be triggered by trivial things like cold air, touch, speaking, shaving, brushing teeth and chewing food. Pain is usually felt in the cheeks, lips, nose, ears, eyes, teeth, jaw, scalp or the entire side of the face. It almost always affects only one side of the face. Unlike migraine headache, the trigeminal pain does not change from one side of the face to the other.

It is very common to find trigeminal neuralgia sufferers refusing to talk /open their mouth. They may cover that part of the face to avoid touch or air contact. Frequently they end up with dentists, thinking it is a dental problem.

What causes trigeminal neuralgia?
It is believed that the trigeminal nerve, as it exits the skull, can get compressed by a blood vessel occasionally, resulting in the trigeminal neuralgia pain. Such compression can injure the trigeminal nerve causing shooting pain. With time, as the compression increases, the duration of pain increases. This is not true in all trigeminal sufferers.

Other causes like multiple sclerosis, aneurysms, tumours, post herpetic neuralgias can also cause trigeminal neuralgia.

How is trigeminal neuralgia diagnosed?
If trigeminal neuralgia is suspected, it is advisable to consult with a neuro physician or pain physician. After having the clinical history and performing a neurological examination, the physician may order a MRI or CT of the brain. Once diagnosis is confirmed, appropriate treatment is started.

How is trigeminal neuralgia treated?
Initial treatment for trigeminal neuralgia includes medications like carbamazepine (tegretol), oxcarbazepine, gabapentin, pregabalin, baclofen, etc. Typically, the medication is started at low doses and adjusted according the effect. With medications, mild cases of trigeminal neuralgia pain can be controlled. Taking long term medications can cause some side effects.

What are the advanced treatment options for trigeminal neuralgia?
If oral medications are not providing adequate satisfactory pain relief or if there are medication related side effects, other advanced options are available. Radiofrequency ablation of the trigeminal ganglion is newer modality of treatment available for trigeminal neuralgia sufferers. Radiofrequency thermal ablation of trigeminal ganglion, performed under x-ray guidance, provides safe, long term relief from trigeminal neuralgia pain.

It is a day care procedure performed under IV sedation. Once RF ablation is performed, patient can stop taking usual oral medications. Percutaneous pain interventional procedures like radiofrequency ablation of trigeminal ganglion are repeatable at a later date, if required.

Trigeminal pain sufferers above 50 years of age are also good candidates for radiofrequency ablations. Older techniques like glycerol injections and balloon compression have been replaced by RF ablations now. Majority of insurance companies including the government schemes approve RF ablation for trigeminal neuralgia sufferers.

What is the role for surgery in trigeminal neuralgia?
Surgeries are reserved for patients, not responding to oral medications and conservative management. It may be suitable for trigeminal neuralgia due to secondary causes like tumours or trigeminal neuralgia in younger patients.

Surgeries called microvascular decompression are offered by neurosurgeons for trigeminal neuralgia. Microvascular decompression surgeries have more risk involved and are costly. If performed successfully, these neuro surgeries can provide long term pain relief. Thanks to the advent of all the above mentioned treatments, trigeminal neuralgia sufferers don’t have to suffer in pain anymore.

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image_1_120x120mar31Dr Karthic Babu Natarajan,
MD, DNB, FIPM, FIPP (USA),
Consultant Pain Physician, Back and Pain Centre,
Apollo Hospitals, Chennai

Dr Karthic Babu Natarajan is a consultant pain physician at Apollo Hospitals. He is a Fellow in Interventional Pain Practice (FIPP) awarded by the World Institute of Pain, Texas Tech University, USA. He is the Honorary Secretary of World Institute of Pain, India and a faculty in Daradia Pain School, Kolkata.

Dr Natarajan, a gold medalist during his MBBS, has completed MD from Kasturba Medical College, Manipal Academy of Higher Education and went on to complete his Diplomate of National Board in Anesthesiology.

Image: Getty Images

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