BRAIN - TRIGEMINAL NEURALGIA

Trigeminal Neuralgia Trigeminal neuralgia is an intermittent, lancinating face pain in one or more divisions of the trigeminal nerve. Characteristically, trigeminal neuralgia has an acute, memorable onset with periods of exacerbation and remission. Trigeminal neuralgia is often triggered by light touch, pressure, or facial sensory stimulation. Typical exacerbating triggers described by patients include brushing the teeth, chewing, cold wind, shaving, and talking. Typical trigeminal neuralgia tends to respond favorably to treatment with carbamazepine. Over time the pain becomes more intense, and the periods of remission fewer and of shorter duration. While the rate of progression is variable, symptoms often progress over time.

The first line therapy of trigeminal neuralgia is medical management with Tegretol (carbamazepine). Many patients achieve long term relief from medical management alone. Although many other medicines have been tried, we are not aware of any other drug with an equivalent efficacy. Additional medications that also may provide relief include phenytoin (Dilantin), baclofen, gabapentin (Neurontin), and clonazepam (Klonopin). When medical management fails due to a lack of efficacy or side effects, surgical options may be considered.

There is no absolute guideline for selecting the best procedure. Procedure selection should consider the patient’s medical condition, prior procedures, and the patient’s willingness to accept the associated risks and benefits of each procedure. The currently available surgical options include microvascular decompression, percutaneous retrogasserian glycerol rhizotomy, radiofrequency rhizotomy, balloon compression, partial neurolysis and Gamma Knife radiosurgery.