A few facts about trigeminal neuralgia

Trigeminal neuralgia causes facial pain.Trigeminal neuralgia develops in mid to late life. The condition is the most frequently occurring of all the nerve pain disorders. Trigeminal neuralgia symptoms may include one or more of these patterns:

•     Occasional twinges of mild pain
•     Episodes of severe, shooting or jabbing pain that may feel like an electric shock
•     Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking and brushing teeth
•     Bouts of pain lasting from a few seconds to several seconds
•     Episodes of several attacks lasting days, weeks, months or longer —some people have periods when they experience no pain
•     Pain in areas supplied by the trigeminal nerve (nerve branches), including the cheek, jaw, teeth, gums, lips, or less often the eye and forehead
•     Pain affecting one side of your face at a time
•     Pain focused in one spot or spread in a wider pattern
•     Attacks becoming more frequent and intense over time

People with trigeminal neuralgia become plagued by intermittent severe pain that interferes with common daily activities such as eating and sleep. They live in fear of unpredictable painful attacks, which leads to sleep deprivation and undereating. The condition can lead to irritability, severe anticipatory anxiety and depression, and life-threatening malnutrition. Suicidal depression is not uncommon.

People often call trigeminal neuralgia "tic douloureux" because of a characteristic muscle spasm that accompanies the pain.

Causes

Usually, the problem is contact between a normal blood vessel — in this case, an artery or a vein — and the trigeminal nerve, at the base of your brain. This contact puts pressure on the nerve and causes it to malfunction.

Trigeminal neuralgia can occur as a result of aging, or it can be related to multiple sclerosis or a similar disorder that damages the myelin sheath protecting certain nerves. Less commonly, trigeminal neuralgia can be caused by a tumor compressing the trigeminal nerve. In other cases, a cause can't be found.

Triggers
A variety of triggers may set off the pain of trigeminal neuralgia, including:

•     Shaving
•     Stroking your face
•     Eating
•     Drinking
•     Brushing your teeth
•     Talking
•     Putting on makeup
•     Encountering a breeze
•     Smiling

Medical Treatment

Because the pain stems from nerves deep inside your skull, no home remedy is effective. Medications used to treat trigeminal neuralgia are those used for many other nerve pain syndromes-drugs originally designed to treat seizures. Pain specialists use invasive therapy, including nerve blocks, nerve destruction, and nerve decompression techniques, as well as drug therapy to treat trigeminal neuralgia.

1. Medications
Medications to lessen or block the pain signals sent to your brain are the most common initial treatment for trigeminal neuralgia.

 Anticonvulsants. Carbamazepine (Tegretol, Carbatrol) is the drug most commonly prescribed — and with the most demonstrated effectiveness — for trigeminal neuralgia. Other anticonvulsant drugs used to treat trigeminal neuralgia include oxcarbazepine (Trileptal), lamotrigine (Lamictal), phenytoin (Dilantin, Phenytek) and gabapentin (Neurontin).

Antispasmodic agents. Muscle-relaxing agents such as baclofen may be used alone or in combination with carbamazepine or phenytoin. Side effects may include confusion, nausea and drowsiness.

2. Alcohol injection
Alcohol injections provide temporary pain relief by numbing the affected areas of your face. Your doctor will inject alcohol into the part of your face corresponding to the trigeminal nerve branch causing pain. The pain relief isn't permanent, so you may need repeated injections or a different procedure in the future. Side effects may include infections at the injection site, bleeding and damage to nearby nerves.

3. Surgery
The goal of surgery for trigeminal neuralgia is either to stop the blood vessel from compressing the trigeminal nerve or to damage the trigeminal nerve to keep it from malfunctioning. Damaging the nerve often causes temporary or permanent facial numbness, and with any of the surgical procedures, the pain can return months or years later.

Alternative medicine

Few clinical studies have been done on the effectiveness of alternative treatments for trigeminal neuralgia, so there's little evidence to support their use. However, some people have found improvement with these treatments. Always ask your doctor before trying an alternative treatment, since it may interact with your other medications.

Complementary and alternative treatments for trigeminal neuralgia include:

•     Acupuncture
•     Biofeedback
•     Vitamin therapy
•     Nutritional therapy
•     Electrical stimulation of nerves