Treatment of trigeminal neuralgia

Trigeminal neuralgia manifests itself as attacks of intense pain in the area of the face, which may occur suddenly and repeat many times throughout the day. Similar symptoms are also observed in other diseases, so it is important to consult a doctor in a timely manner to determine the cause.

At the medical center «Oxford Medical», diagnosis and treatment of trigeminal neuralgia and other diseases of the nervous system are provided. After the examination, the doctor establishes the diagnosis, determines the cause of the disease, and selects an individual treatment strategy. To schedule an appointment, submit a request through the online appointment form on the website or contact the clinic's contact center.

Trigeminal neuralgia is a disease in which the normal transmission of nerve impulses along the trigeminal nerve is disrupted, which leads to the appearance of characteristic pain attacks. In medical literature, this condition is also called trigeminal neuralgia.

In this disease, nerve impulses are transmitted incorrectly, so pain may occur even in response to a minor irritant. Trigeminal neuralgia may have different mechanisms of development, so when choosing treatment, the doctor takes into account the cause of the disease, the nature of the pain, and the results of the examination.

The trigeminal nerve is the fifth pair of cranial nerves. It arises from the brainstem, passes in the area of the base of the skull, and branches into three main branches that provide sensitivity to different areas of the face.

Doctors at «Oxford Medical» explain: the trigeminal nerve is mainly responsible for facial sensitivity, while movements of the facial muscles are controlled by the facial nerve. That is why facial nerve neuritis and trigeminal neuralgia are different conditions, although their manifestations may seem similar. To correctly determine the cause of the complaints, it is necessary to consult a doctor.

The most common cause of neuralgia is compression of the nerve root by a vessel in the area where it exits the brainstem. According to National Institute of Neurological Disorders and Stroke, secondary neuralgia may be associated with other diseases, in particular tumors, vascular malformations, or demyelinating processes.

Possible causes and factors in the development of the disease may include:

• vascular compression of the trigeminal nerve;

• demyelinating diseases, in particular multiple sclerosis;

• neoplasms;

• vascular malformations;

• dental interventions, in particular wisdom tooth removal;

• injuries to the face or head;

• ENT diseases, in particular pronounced rhinitis or inflammation of the paranasal sinuses.

In some patients, pain may be associated not with one, but with several factors simultaneously. For example, against the background of chronic ENT diseases, previous interventions in the jaw area, or vascular changes, irritation of nerve structures may intensify, which affects the course of the disease.

Pain of the trigeminal nerve often has a clear area of spread — depending on which branch is involved. For example, it may be felt in the area of the upper or lower jaw, because of which patients sometimes first consult a dentist.

Diagnosis begins with a consultation with a neurologist. The doctor clarifies where exactly the pain occurs, how long the attacks last, what provokes them, and whether there are periods of complete relief between them. It is also important to find out whether there were previous facial injuries, dental interventions, ENT diseases, or neurological diseases.

During the examination, the neurologist assesses the sensitivity of different areas of the face, the symmetry of facial expressions, and reflexes. This helps determine whether there are signs of trigeminal nerve damage, which branch may be involved, and whether the pain is not associated with other conditions.

To clarify the diagnosis, additional examination methods may be used:

• magnetic resonance imaging of the brain;

• MR angiography to assess the condition of the vessels;

• laboratory tests according to individual indications;

• other instrumental studies, if it is necessary to exclude concomitant causes of pain.

According to NHS, MRI is often used during the diagnosis of neuralgia to assess possible causes of facial pain. MRI can help detect vascular compression of the nerve, space-occupying neoplasms, signs of demyelinating processes, and other conditions.

After the examination, the doctor compares the complaints, examination results, and instrumental diagnostic data. This makes it possible to distinguish neuralgia from dental pain, sinusitis, migraine, facial nerve neuritis, and other diseases that may have similar manifestations.

The basis of treatment usually consists of medication therapy. According to US National Library of Medicine, in trigeminal neuralgia, medications are used that help reduce excessive excitability of nerve structures and control pathological pain impulses. The doctor selects the regimen individually, so it is not allowed to take such medications independently or change the dosage.

Medication treatment may include:

• medications for controlling neuropathic pain;

• anticonvulsant medications that reduce excessive activity of nerve impulses;

• pain-relieving agents according to indications;

• anti-inflammatory or anti-edematous medications, if there are signs of an inflammatory process or tissue swelling;

• additional medications to support the nervous system by the doctor’s decision.

Doctors at «Oxford Medical» explain: if the trigeminal nerve is affected, treatment cannot be the same for all patients. The choice of medications depends on the cause of pain, the intensity and frequency of attacks, the patient’s age, concomitant diseases, and the body’s response to therapy.

The goal of treatment is to reduce the intensity and frequency of attacks, achieve stable pain control, and prevent repeated exacerbations. The earlier the patient consults a neurologist, the greater the chances of selecting effective therapy.

To relieve the condition during a pain attack, you can:

• take the medications prescribed by the neurologist according to the recommended regimen;

• avoid triggers that provoke pain: cold, wind, sudden touch to the face, chewing hard food, very hot or cold drinks;

• if necessary, carefully apply dry moderate heat to the area of muscle tension, but do not heat the face intensely and do not use hot compresses;

• do not actively massage the painful area, and if there is a feeling of tension, you can very carefully relax the muscles around it without strong pressure.

If the pain repeats, becomes more frequent or more intense, it is necessary to consult a neurologist. The doctor will assess the cause of the attacks, select therapy to control neuropathic pain, and explain which actions are better to avoid specifically in your case.

Without treatment, pain attacks may recur more and more often, and their intensity may increase. In some patients, pain begins to occur even during ordinary everyday actions: talking, brushing teeth, washing the face, or chewing.

Possible consequences of a prolonged course of the disease are:

• increased frequency and intensification of pain attacks;

• development of chronic neuropathic pain;

• sleep disturbance due to repeated night or morning attacks;

• increased anxiety associated with the constant expectation of pain;

• late detection of the disease that caused damage to the trigeminal nerve, if a person engages in self-treatment for a long time.

Doctors at «Oxford Medical» recommend not waiting until the pain becomes regular or begins to recur more often. Timely diagnosis makes it possible to establish the cause of the disease, select effective treatment, and reduce the risk of symptom progression.

Treatment of trigeminal neuralgia begins with a consultation with a neurologist. During the appointment, the doctor performs an examination, if necessary prescribes additional examinations, and determines the optimal treatment strategy. The final cost depends on the scope of diagnostics, the need for additional consultations, and the prescribed therapy.

You can find out the current prices for doctors’ consultations here. During the appointment, the specialist will orient you regarding the cost of the necessary medical services and answer all questions. To schedule a consultation, leave a request through the online appointment form on the website or contact the clinic’s contact center.

The information is for informational purposes and does not replace a doctor’s consultation.

Sources:

• US National Library of Medicine

• National Institute of Neurological Disorders and Stroke

• NHS — Trigeminal neuralgia