Trigeminal neuralgia is a chronic pain disorder characterized by severe facial aching. The pain may be sudden and sporadic, causing stabbing, electric-like shocks down one side of your face, or it may be a constant, less severe, and more widespread form of burning discomfort.
Sometimes described as “the most excruciating pain known to humanity,” trigeminal neuralgia can trigger pain episodes that are intense enough to bring daily life to a grinding halt. Luckily, there are effective medical treatments and complementary therapies that can help.
Fellowship-trained neurosurgeon Dr. Jose Valerio takes a closer look at this debilitating pain problem — and the treatment options that can deliver much-needed relief.
Also known as tic douloureux, trigeminal neuralgia stems from a problem with the trigeminal nerve, or the cranial nerve that provides touch, temperature, and pain sensations to your face. The trigeminal nerve has three branches rooted in your brain:
Abnormal contact with a blood vessel that compresses the nerve and causes it to misfire typically yields primary trigeminal neuralgia. Secondary trigeminal neuralgia occurs when an abnormal growth (i.e. tumor) puts pressure on the nerve or when multiple sclerosis (MS) or a traumatic injury damages the nerve’s protective coating (myelin sheath).
Whether your trigeminal neuralgia causes brief, intensely sharp shooting pain attacks (type 1) or constant widespread facial achiness punctuated by periodic stabbing or burning sensations (type 2), your symptoms probably go in cycles.
In most cases, trigeminal neuralgia causes lengthy stretches of frequent pain attacks followed by varied intervals (days, weeks, months, or years) of no pain. Usually, the pattern of pain episodes intensifies as time goes on, with shorter pain-free periods in between.
Treatment accomplishes pain relief and helps control the condition’s progression over time. Interventional trigeminal neuralgia pain management may involve one treatment or a combination of the following treatments:
An anticonvulsant medication, carbamazepine, is often the first-resort treatment option for type 1 trigeminal neuralgia pain. While anticonvulsants aren’t pain relievers, they can alleviate pain by blocking nerve signals. Carbamazepine works well for many people in the earliest stages of the condition, but its efficacy decreases over time.
If carbamazepine isn’t an option because of its side effects, another anticonvulsant drug (i.e., gabapentin, oxcarbazepine) may be able to deliver safe, effective relief.
Muscle relaxant medications can be combined with anticonvulsant drugs for more effective relief when your facial pain is severe. Botox® or nerve block injections can also help deliver immediate, temporary relief when needed.
When medication doesn’t provide effective relief or causes intolerable side effects, surgical treatment is often the next best step. Dr. Valerio may recommend the following:
This non-invasive procedure delivers a highly targeted, concentrated beam of radiation to the trigeminal nerve root at your brain stem, which causes a lesion to form on the nerve root, disrupting its ability to transmit pain signals. Stereotactic radiosurgery results usually last for about three years.
Several percutaneous (through the skin) procedures relieve pain with a minimally invasive needle insertion or thin tube (catheter).
With balloon compression surgery, Dr. Valerio inserts a catheter with a tiny balloon through your cheek to the trigeminal neuralgia. He inflates the balloon, compressing the pain-causing nerve fibers so they can no longer transmit pain signals. He removes the balloon and catheter at the end of the procedure. In most cases, results typically last for one to two years.
MVD surgery is the most invasive treatment, yet it is most effective for providing long-lasting pain relief. With this operation, Dr. Valerio opens your skull at the site of your trigeminal nerve root (behind the ear) and locates the blood vessel compressing the nerve. Then, he places a tiny cushion between the nerve and the blood vessel to separate them. MVD can provide pain relief for ten years or longer.
Some people find improved relief with medication when they engage in complementary therapies like yoga, meditation, low-impact exercise, and creative visualization. Counseling, acupuncture, and nutritional therapy may also be helpful.
Each treatment approach for trigeminal neuralgia has its benefits and drawbacks. Dr. Valerio explains how each option’s pros and cons pertain to you, enabling you to make an informed decision about your care.
If you’ve been living with trigeminal neuralgia pain, we can help. Call your nearest office in South Miami, Hialeah, or Weston, Florida, today to schedule an evaluation at Jose Valerio, MD.
