Trigeminal neuralgia is a type of pain that affects the trigeminal nerve.
This fifth cranial nerve brings the sensation from the face to the brain and enters the
skull right above the ear.
The person has pain triggered by touching the skin, the mouth, talking, chewing, shaving,
cold winds, cold foods, or drinks.
The pain is like an electrical shock, very brief and sharp.
This video is the third in a series about headaches.
My previous videos are about migraine and cluster headaches.
Stay tuned to the end, and I’ll tell you about the next videos.
So, let’s talk about trigeminal neuralgia today.
Trigeminal neuralgia can be caused by anything that compresses or irritates the trigeminal
nerve.
The compression can be due to a tumor or a blood vessel close to the nerve.
There are some diseases that affect the nerve, like multiple sclerosis, shingles, or herpes
viruses.
Therefore, it is a secondary type of headache.
The pain can occur by a trigger, but it can also happen spontaneously.
There might be periods when the attacks are more frequent and periods of remission.
The trigeminal nerve has 3 branches: the ophthalmic, mandibular and maxillary.
The pain is usually felt in the affected branch of the trigeminal nerve.
Usually the pain is felt in the cheek, mouth, gum, or teeth.
It rarely affects the eye or forehead.
Some patients go to the dentist and suggest removing a tooth, but this usually does not
resolve the problem, and in fact, it can make the pain even worse.
The pain rarely occurs when the person is sleeping.
Trigeminal neuralgia affects people of any age, but it is more common above 50.
If a young person has trigeminal neuralgia, they need to be investigated for multiple
sclerosis and other causes.
Before I continue, let me remind you that this video is not intended to replace medical
advice.
It is for educational purposes only.
Please talk to your doctor about the diagnosis and treatment plan for you.
In case of emergency please go to the nearest emergency department or call an ambulance.
There is no test or imaging that can diagnose trigeminal neuralgia.
Usually, an imaging test is done to rule out a tumour or multiple sclerosis.
The first-line treatments include: Anticonvulsant medications, like carbamazepine,
oxacarbazepine, phenytoin, gabapentin, pregabalin, and lamotrigine.
Another type of medication includes baclofen, a drug used to treat spasticity of the muscles.
We don’t use opioids, but in severe cases they could be tried for a short period.
We should only use for a very short time to avoid dependence, addiction, and medication
overuse headaches.
If a tumour or blood vessel compresses the nerve, the person needs to see a neurosurgeon
for an option to decompress the nerve.
There are various surgical options for trigeminal neuralgia
Microvascular decompression involves removing the blood vessel which is compressing the
nerve behind the ear.
If the blood vessel is an artery, then the neurosurgeon will place a cushion between
the nerve and the artery.
If the blood vessel is a vein, they will remove the vein.
Sometimes they may also cut some portions of the trigeminal nerve.
This procedure can eliminate the pain entirely or reduce it a lot.
But of course, this procedure has many risks, like impairing the hearing function, causing
muscle weakness in the face, or numbness in the face.
The other surgical procedure involves radiation therapy, called gamma knife, to the root of
the trigeminal nerve.
It uses radiation to block the nerve and stop the pain.
The results are obtained in a couple of days up to a month.
Usually, the person feels numbness in the face after this procedure.
The pain may recur in a few years, and the procedure can be repeated.
Other procedures can be used, like destroying the trigeminal nerve fibers.
In this case, the person will lose the sensation on that side of the face.
The destruction can be obtained with injections of glycerol, by applying pressure to the nerve
using a balloon, or even by using radiofrequency thermal lesions, which is a kind of heated
electrode that will damage the nerve by heat.
I made this video series in collaboration with Migraine Canada.
If you want to learn more about headaches and migraines, visit their website.
They have a lot of resources, events, and education materials for you to learn more
about migraines.
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I will release videos about tension-type headaches and cervicogenic headaches in the following
weeks.
Thank you for watching.
Goodbye!