The cause of trigeminal neuralgia is not exactly known.
- According to some experts it is caused by traumatic damage to the nerve as it passes from the openings in the skull to the muscles and tissue of the face. The damage results in compression of the nerve and the associated symptoms.
- According to others trigeminal neuralgia is caused due to biochemical change in the nerve tissue itself.
- Recent theory believes that an abnormal blood vessel compresses the nerve as it exits from the brain and results in trigeminal neuralgia.
However in all cases, it is the excessive burst of nervous activity from a damaged nerve that causes the painful attacks.
The characteristic feature of trigeminal neuralgia is the trigger zone i.e. a small area in the central part of the face, usually on a cheek, nose, or lip, which on stimulation triggers a typical burst of pain. A light touch or vibration is the most frequent and effective trigger. As a result even common daily activities trigger the attacks.
Common daily activities that can trigger pain are:
- Washing face, brushing teeth, shaving, or talking
- Common sensations like the blowing wind on your face
- Eating and chewing, as a result many people avoid food and drink rather than suffer the severe pain.
Some people may need hospitalization for rapid pain control if the pain becomes unmanageable at home.
Tests and diagnosis
Your doctor will take a comprehensive medical history and do a thorough physical examination. Physical examination of the head in people with trigeminal neuralgia is normal.
Medical history may include questions regarding pain like how severe is it, what part of your face is affected, how long does it lasts and what seems to trigger it. Your doctor will conduct a neurological examination, during which he or she examines and touches parts of your face to try to determine exactly where the pain is occurring and the branches of the trigeminal nerve that are affected.
As facial pain can be caused by various disorders, an accurate diagnosis is essential. Your doctor may order tests such as computed tomography (CT) scan or magnetic resonance imaging (MRI) scan to rule out associated condition, such as skull or brain tumor, infection, or neurological condition.
Most people with trigeminal neuralgia respond to medications and require no surgical treatment. Hence medications are usually the initial treatment for trigeminal neuralgia.
The commonly used medications for relieving pain in trigeminal neuralgia include:
- Anticonvulsants: Anticonvulsants such as carbamazepine, phenytoin, and oxcarbazepine are the most common anticonvulsant medications used to treat trigeminal neuralgia. Anticonvulsants like lamotrigine or gabapentin are also used in some patients. However the anticonvulsant medications are associated with several side effects like dizziness, confusion, drowsiness, double vision and nausea. An increased risk of suicidal thoughts and behaviour has been observed as well. So if you are on these medications have regular follow up with your doctor.
- Muscle relaxants: Antispasticity agents or muscle-relaxing drugs (such as baclofen, chlorzoxazone, methocarbamol, diazepam) are often used alone or in combination with carbamazepine or phenytoin to relieve pain. Regular follow up with your doctor is recommended.
- Alcohol injection: Repeated injections may be needed as the pain relief isn't permanent.
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