Trigeminal Neuralgia Treatment

What is Trigeminal Neuralgia (Facial Pain)?

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What Causes Trigeminal Neuralgia (Facial Pain)?

In many cases, trigeminal neuralgia is caused by pressure on the nerve. This can happen due to a blood vessel pressing against the trigeminal nerve as it exits the brain stem, causing it to malfunction. Factors such as ageing and certain diseases like multiple sclerosis can damage the myelin sheath, which protects the nerves and contributes to the development of trigeminal neuralgia.

Primary (classic) TN

Primary TN occurs when a blood vessel near the brainstem compresses the trigeminal nerve root, triggering intense facial pain.

Secondary TN

Secondary Trigeminal Neuralgia occurs when diseases like multiple sclerosis or structural abnormalities such as tumours press on the trigeminal nerve.

Idiopathic TN

Idiopathic trigeminal neuralgia is diagnosed when no physical causes like nerve compression or disease are found despite thorough diagnostic tests. This uncertainty often complicates treatment approaches, as the exact pain triggers remain elusive.

What Are the Symptoms of Trigeminal Neuralgia (Facial Pain)?

Pain arises from the trigeminal nerve (fifth cranial nerve) and manifests as sharp, shooting pain lasting a few seconds to minutes. It typically occurs on one side of the face, often around the cheek, jaw, or lower part of the face. The episodes can occur several times a day, and in some cases, the pain can become constant. The intensity and frequency of the trigeminal neuralgia pain can be debilitating, severely impacting the quality of life.

Trigeminal Neuralgia Symptoms to Watch For:

• Eating or drinking
• Talking and smiling
• Brushing, flossing, and rinsing with mouthwash
• Exerting any pressure on the face, particularly along the cheek or jawline
• Applying makeup or washing your face
• Experiencing even a slight breeze or a swift gust of wind against your face

How is Trigeminal Neuralgia Diagnosed?

Diagnosing trigeminal neuralgia primarily involves a detailed review of the patient's medical history and symptoms. Physicians perform a comprehensive neurological examination to rule out other causes of facial pain, focusing on the areas where pain is experienced to determine if the trigeminal nerve is affected.

To confirm the diagnosis and exclude secondary causes such as tumours or multiple sclerosis, Magnetic Resonance Imaging (MRI) is utilised. This imaging helps to detect any vascular compression or pathological changes that might be impacting the trigeminal nerve, guiding further treatment options and potential surgical interventions if necessary.

Types of Trigeminal Neuralgia (Facial Pain) Treatment in Singapore

Medications

First-line treatment options often include medications such as carbamazepine, gabapentin, or pregabalin. These medications work by slowing down nerve signals, which helps to reduce the speed at which pain messages are sent to the brain. Other medications like muscle relaxants or certain antidepressants may also be considered depending on the specific case.

Radiofrequency (RF) Ablation

When medication therapy fails to provide sufficient relief or produces intolerable side effects, Radiofrequency Ablation can be an option. This is a minimally invasive treatment that uses high-frequency waves to produce heat, which is then used to damage specific nerves and interrupt their ability to transmit pain signals to the brain. A special RF needle is inserted into the trigeminal ganglion, the main part of the nerve that is causing the pain.

RF energy is then generated through a machine to create heat, which is transmitted through the needle tip to destroy the painful division of the trigeminal nerve. This is a day surgery procedure that is performed using CT scan guidance under mild sedation

Gamma Knife Radiosurgery

Another option for those who are not responding well to medications is Gamma Knife Radiosurgery. This treatment uses focused radiation beams to target the trigeminal nerve, disrupting the transmission of pain signals without the need for an incision.

Microvascular Decompression

Microvascular Decompression is a surgical procedure that involves relocating or removing blood vessels that are in contact with the trigeminal root. This alleviates the pressure that is causing the nerve to malfunction and transmit pain signals.

Each of these trigeminal neuralgia treatment options has its own set of risks and benefits, which should be thoroughly discussed with your pain medicine physician to determine the most appropriate treatment for you.

When to See a Doctor for Trigeminal Neuralgia?

It's recommended to consult with a doctor for a thorough evaluation if you experience any of the following:

• Sharp or stabbing facial pain
• If the pain is affecting your quality of life
• If the episodes of pain become more frequent or intense
• If over-the-counter pain medications are not providing relief
• If the symptoms are causing you distress or are affecting your ability to eat, speak, or perform daily activities

What to Expect During Your Trigeminal Neuralgia Treatment Appointment

• Initial Consultation:
• A detailed discussion about your symptoms, medical history, and any previous treatments you have tried.
• Diagnostic Evaluation:
• Our pain specialists will conduct a physical examination and possibly recommend diagnostic tests such as MRI scans to pinpoint the exact cause of the trigeminal neuralgia symptoms.
• Treatment Planning:
• We will discuss the most suitable treatment options tailored to your condition based on the findings.
• Follow-up Scheduling:
• If treatment is initiated, follow-up appointments will be scheduled to monitor your progress and adjust treatments as necessary.