Treatment Options For Trigeminal Neuralgia

April 30, 2024

Trigeminal neuralgia is a condition that causes chronic pain in the face by affecting the trigeminal nerve, which is responsible for bringing sensations from the face to the brain. When an individual has this condition, any stimulation of their face might cause jolts of pain, even gentle routines like applying makeup or brushing their teeth. At the onset, the attacks tend to be short and mild.

However, trigeminal neuralgia tends to progress and become more severe, causing more frequent and more intense pain. Women are more likely to have the condition than men, and the condition more commonly appears in those over fifty years old. There are multiple treatment options available, so patients aren't necessarily doomed to pain if they have trigeminal neuralgia.

Microvascular Decompression

Microvascular decompression is a surgical treatment option that releases abnormal compression of certain cranial nerves. It's used to treat trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia. During this surgery, the surgeon will open the patient's skull and insert a sponge between the artery causing the pain signals and the nerve. This keeps the artery from sending more pain signals. Most doctors will recommend treating trigeminal neuralgia with medications first.

However, if pain medications cause too many dangerous side effects or aren't effective enough, patients might benefit from microvascular decompression. In many cases of trigeminal neuralgia, the trigeminal nerve is compressed by a blood vessel that increases pressure and causes a pulsing effect. Using a sponge to separate the blood vessel helps isolate the nerve, stopping it from carrying the pain signals to the brain.

Anticonvulsant Medication

Anticonvulsant medication is one of several medication options available for individuals with trigeminal neuralgia. The most common type of medication is carbamazepine, which has shown effectiveness in multiple studies regarding trigeminal neuralgia treatment. There are other anticonvulsants that may also be used like lamotrigine, oxcarbazepine, and phenytoin. If these aren't effective, doctors might use benzodiazepines like clonazepam. In many cases, using carbamazepine can lead to immediate relief.

However, the symptoms may recur within six to twelve months, even if they aren't as severe. Some patients stop using their medication when the symptoms recur, and they eventually have to start medication again. It's always best for patients to talk to their doctor before stopping any medication, provided the medication isn't causing potentially life-threatening symptoms.

Brain Stereotactic Radiosurgery

Brain stereotactic radiosurgery, otherwise known as Gamma Knife radiosurgery, isn't actually a surgical procedure. Like other types of stereotactic radiosurgery, this procedure doesn't involve an incision. Rather than cutting into the body, the procedure uses special equipment to focus around two hundred tiny radiation beams on the target. Since the technology is accurate to within a millimeter or so, the procedure can target one specific area of the brain without damaging healthy tissues. In most cases, it's used to treat brain tumors. With trigeminal neuralgia, the procedure targets the place the trigeminal nerve enters the brain stem.

Rather than treating the underlying cause of the pain, the procedure damages the nerve so it is unable to transmit pain signals. This is the least invasive non-medication treatment option for trigeminal neuralgia, so it's a good choice for patients who cannot take certain medications but also cannot risk the complications associated with invasive surgery. Patients tend to require little or no anesthesia for the treatment. It should be noted the results from radiosurgery often take longer to appear than with other treatments. Rather than being immediately effective, they might take anywhere from four weeks to eight months for a full response.

Radiofrequency Thermal Lesioning

Radiofrequency thermal lesioning is a medical procedure in which specialized needles create lesions along specific nerves. The needles cause the nerve to reach a temperature of eighty degrees Celsius. The heat is applied for around two to three minutes, which deadens the nerve's ability to send pain signals. Though the body attempts to regrow blocked nerves, the process might take a year or longer. Some patients have seen a reduction in their symptoms for at least twelve months.

Radiofrequency lesioning is usually used in trigeminal neuralgia and other conditions caused by nerve pain from the facial nerves. Before a patient can undergo a lesioning treatment, they must have shown good responses to local anesthetic blocks previously. Radiofrequency thermal lesioning is much more effective in those who have responded well to having their nerves temporarily blocked. About seventy to eighty percent of patients report their nerve is blocked well enough to relieve some pain. In some cases, blocking the nerve will help isolate pain caused by other nerves as well.

Antispasmodic Medication

Antispasmodic medication may be used, sometimes in conjunction with anticonvulsants or benzodiazepines, to treat trigeminal neuralgia. One of the most common types used is baclofen, though dantrolene and tizanidine may also be used. The goal of antispasmodic medication is to reduce or smooth muscle spasms. Though the medication is most commonly used to help with muscle spasms in the digestive tract, it can also help with any condition that leads to muscle contractures or spasms.

One underlying cause of trigeminal neuralgia may be that a muscle is spasming and sending pain signals to the nerve, and relieving the muscle spasm should help relieve the pain. Antispasmodic medications can help with muscle spasms caused by neurological conditions like multiple sclerosis and cerebral palsy as well. If trigeminal neuralgia leads to muscle spasms, the medication can also help treat these.

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