Trigeminal Neuralgia

A chronic pain condition affecting the trigeminal nerve of the cranium. Trigeminal neuralgia (TN) can produce a variety of headache pain, ranging from sudden, severe, and stabbing pain to a more constant aching or burning sensation. Activities such as eating, drinking, brushing teeth, talking, or shaving can trigger sudden, intense pain.

TN may be caused by a blood vessel pressing against the trigeminal nerve or by multiple sclerosis, both of which can damage the protective myelin sheathe around the nerve. Any injury to the trigeminal nerve — from sinus surgery, oral surgery, stroke, or facial trauma — can also cause TN.

TN is difficult to treat, but several therapies may offer some relief. Anticonvulsant medications such as carbamazepine, gabapentin, and clonazepam and tricyclic antidepressants such as amitriptyline and nortriptyline may help alleviate pain. If these medications fail to adequately relieve symptoms or produce intolerable side effects, various surgical procedures may help. Balloon compression, glycerol injection, and radiofrequency ablation all damage nerves to prevent transmission of pain signals and bring relief. Stereotactic radio surgery focuses beams of radiation to intersect where the trigeminal nerve exits the brain stem. In microvascular decompression, the surgeon moves the blood vessel pressing on the trigeminal nerve and places a soft cushion between the nerve and the blood vessel. The surgeon also may perform a neurectomy or a partial nerve section. Low-impact exercise, yoga, creative visualization, meditation, acupuncture, chiropractic treatments, and biofeedback also can offer relief and a greater sense of well-being.

Robert S. Dinsmoor, a medical writer and editor based in Massachusetts, is a contributing editor of Diabetes Self-Management.

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