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Trigeminal Neuralgia

Trigeminal neuralgia or Tic douloureux is a chronic painful and debilitating disease affecting the facial area of the patient. The culprit in this condition is the Trigeminal nerve which carries sensations from your face to your brain. This is a rare disorder with an annual incidence of 4.5 per 100000 people.

The neuropathic pain associated with Trigeminal neuralgia is so excrutiating that it is also called a the 'suicide disease'.


Trigeminal nerve has three branches which carry sensations from the face to the brain:


    1) Ophthalmic branch : This is the Upper branch and supplies sensation to most of the scalp, forehead, and front of the head.

    2) Maxillary branch : This is the Middle branch and supplies the cheek, upper jaw, top lip, teeth and gums and the side of the nose.

    3) Mandibular branch : This is the Lower branch which supplies nerves to the lower jaw, teeth and gums, and bottom lip.

    In Trigeminal neuralgia one or more branches can be affected at the same time. Though rare, both sides of the face may be affected at different times in the same individual and very rarely at the same time.

Classification


Depending on the etiology, Trigeminal neuralgia is classified into

  • Idiopathic Trigeminal neuralgia: Where cause is unknown
  • Classical Trigeminal neuralgia: Wherein, demonstrable changes in Trigeminal nerve root from vascular compression can be seen in MRI brain
  • Secondary Trigeminal neuralgia: Secondary to major neurological pathologies like Tumors or Multiple Sclerosis.
  • Trigeminal neuralgia with continuous pain: Also called as Atypical Trigeminal neuralgia, it is characterized by presence of continuous pain in the area of distribution of Trigeminal nerve against the paroxysms seen in other types. It can even Co-exist along with other types of Trigeminal neuralgia.

Signs and Symptoms


  • Severe electric shock like shooting pain over the face
  • Pain or attacks activated by touching the face, biting, talking or brushing
  • Pain areas include the ear, eyes, forehead, jaw, or mouth and face
  • Over sensitivity, sensitivity to pain, or uncomfortable tingling and burning
  • Can be only one attack of pain, some may experience sharp pain every hour or every few seconds

JEEVISHA protocol for management of Trigeminal neuralgia :


Diagnosis of Trigeminal neuralgia is of utmost importance as it shares some clinical features with Atypical facial pain, Temporo-mandibular joint disorders etc. Diagnosis is mainly through history of the patient and clinical examination. Patients are also advised to undergo MRI Brain to rule out secondary causes of Trigeminal neuralgia. We at JEEVISHA Pain Management Center specialise in diagnosis and treatment of all kinds of Atypical facial pain and its adequate management.

  • Medications and other conservative treatment options: Patients are generally started on Neuropathic and Anti- Convulsant medications. Doses are slowly titrated to get the adequate pain relief with minimum side effects. However, if used alone, most of patients develop tolerance or side-effects to the prescribed medications. Thus, at our centre we use Multiple modalities which when combined prevent early development of side effects of the medications. These include
  • Perineural Dry needling in the area of distribution of the particular branch involved
  • Botox injections which not only reduce the muscle spams associated with this condition but also produce neuromodulation and subsequent reduction in disease symptoms
  • Pain shield: It is a patch which has to be applied over the affected face area and it provides ultrasound therapy to the affected nerve branches.

Targeted treatment:


  • Fluoroscopy guided Radiofrequency ablation of the Gasserian ganglion of Trigeminal nerve
  • Balloon compression of the Gasserian ganglion of Trigeminal nerve