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Trigeminal Neuralgia: Treatment, Procedure, Cost and Side Effects

Last Updated: Nov 01, 2021

What is the treatment?

Trigeminal neuralgia is a condition that results in chronic pain in the face, particularly in the trigeminal nerve. This condition often occurs in women who are aged over 50, however there are fewer than a million cases per year in India, making this condition a rare one. The pain experienced as a part of this condition can often be triggered by speaking, chewing, or brushing the teeth. There is no cure for this condition and the treatment options mainly focus on making it a more manageable condition to live with.

Trigeminal neuralgia is treated with the help of medications. The medicines that will be prescribed function by blocking the pain receptors so that you don’t feel it. Pain management is a large part of living with this condition and you may be prescribed anti-spasmodic medicines, anticonvulsants, or even botox injections to help you with the pain. However, medication is not the only answer. There are many surgical procedures that can be used to control this condition and make it easier to live with. Some of the surgical options include microvascular decompression and brain stereotactic radio surgery. Since this condition occurs mainly in women over 50, the treatments that are employed take into consideration the patient’s medical history and age. Once the severity of the pain is mapped, the doctor will decide what treatment options will suit you the most.

What is Type 2 Trigeminal Neuralgia?

Trigeminal Neuralgia is a syndrome related to the trigeminal nerve and characterized by severe episodes of unilateral facial pain. It is of two types: Type1 and Type2 which differ in the nature of pain associated. Type2 Trigeminal Neuralgia is accompanied by pain which is constant in nature, contrary to Type1 in which the nature of the pain being sudden and sharp, is not constant.

Does Trigeminal Neuralgia show on MRI?

MRI or Magnetic resonance imaging is a diagnostic technique that is associated with the study of various brain diseases or syndrome including Trigeminal Neuralgia. This imaging procedure is usually indicated in the cases of Trigeminal Neuralgia when the patient’s age is less than 60 years. The main purpose of this diagnostic procedure is to get information about the secondary causes of Trigeminal Neuralgia. Based on the study of this imaging modality, the treatment plan may be decided.

How is the treatment done?

Trigeminal neuralgia is diagnosed on the basis of the type of pain you are experiencing, the part of the face that hurts, and the triggers that activate the pain. With this condition, the pain is often short and sharp and triggered by any stimulation to the cheeks, such as chewing, speaking, or even brushing your teeth. A neurological examination can help doctors understand what is causing the pain. In some cases, an MRI scan is also recommended to get a clearer picture of the problem. Once trigeminal neuralgia is diagnosed, the treatment can begin.

When it comes to the medicines that can be prescribed for this treatment, they range in type from antispasmodic and anticonvulsants, to botox injections. Anticonvulsants can help control the trigeminal nerve in the face in order to lessen the pain. Antispasmodic medications also work on a similar principal. Botox injections are also known to lessen the pain in the nerve, however further studies may be needed to substantiate this.

Trigeminal neuralgia can also be controlled with the help of surgical options. With microvascular decompression, an incision is made behind the ear on the side of the face where you feel the pain. The doctor removes the arteries and veins that come in contact with the nerve, and then adds a soft cushion between the nerve and other arteries. With brain stereotactic radio surgery, the goal is to destroy the root of this nerve. A controlled shot of radiation is given to the nerve to make it stop functioning. The relief in this form of treatment is gradual, but the treatment itself can be very effective. By destroying the nerve, you eliminate the chances of it transmitting the pain to your brain.

Does Trigeminal Neuralgia go away?

Trigeminal Neuralgia is a disorder related to the trigeminal nerve. It is accompanied by severe pain in the facial region that may be spontaneous or not. With the treatment, it usually gets better in most cases while in some cases it subsides down itself. There are possible chances of recurrence which happens after a gap of the time period.


Who is eligible for the treatment of Trigeminal Neuralgia? (When is the treatment done?)

Once trigeminal neuralgia is diagnosed, you can seek out the treatment. It is better to start with the medicinal treatments before going in for surgery. However, if they don’t work, you can certainly explore the surgical options.

Who is not eligible for the treatment of Trigeminal Neuralgia?

Sometimes, pain in the face is caused to due multiple sclerosis. It may imitate the symptoms and signs of trigeminal neuralgia but it is an entirely different condition. If you are suffering from multiple sclerosis, then seeking out treatment for trigeminal neuralgia will not help you with your condition. The doctor must treat the sclerosis first for you to experience any relief from the pain.

Is Trigeminal Neuralgia serious?

Trigeminal Neuralgia is accompanied by intense episodes of pain, which is unilateral in nature. It is a kind of acute radiating pain that travels through the face and feels like an electric shock. A person becomes unable to eat or drink due to the severity of pain. The duration of such stabbing pain lasts for minutes or even more. It gets triggered by some factors such as brushing, eating, or drinking or due to anything that touches the face. The person suffers from depression too due to the fear of pain.

Are there any side effects of Trigeminal Neuralgia?

As is the case with most treatments, there are certain side effects to be vary of. Anticonvulsants can lead to side effects like dizziness, nausea, drowsiness, and confusion. Certain anticonvulsants have negative effects on people with Asian descent. Antispasmodic agents also have a few side effects such as confusion, drowsiness, and nausea. Multiple botox injections can eventually make it harder to move your face naturally. It can also give you a stiff and shiny appearance. Microvascular decompression has side effects that include stroke, facial numbness, loss of hearing, and facial weakness. Brain stereotactic radio surgery can lead to developing numbness in the face as well. Surgery in general comes with side effects like bruising, swelling, and pain.

What are the post-treatment guidelines of Trigeminal Neuralgia?

With some medications, you have to monitor your diet and control your lifestyle. Since trigeminal neuralgia can mostly be treated through pain management techniques, identifying and controlling your exposure to your triggers can go a long way in helping you. For instance, if your trigger is a cold breeze that brushes against your cheek, you may have to limit your exposure to the same.

How long does it take to recover of Trigeminal Neuralgia?

It can take up to a month for the treatment to start taking effect.

What is the price of the treatment in India?

The surgical treatments range in price from Rs. 50,000 to Rs. 1,50,000, depending on where you are getting the procedures done from.

Are the results of the treatment permanent?

There is no cure for trigeminal neuralgia, therefore the treatment results cannot be permanent. The treatment focusses on reducing and managing the pain you feel and you can expect the pain to swing from low to high throughout your life. The trick is to identify the treatment options that work best for you and continue to administer them as and when they are needed.

What foods to avoid if you have Trigeminal Neuralgia?

In the case of Trigeminal Neuralgia, certain food items are there that act as triggering factors for the pain. Such foods that need to be avoided in this case include hot and spicy foods as well as cold foods and drinks. Using a straw to have these might help. Liquid meals are preferred since chewing solid foods may act as an aggravating factor to stimulate the pain. Caffeine, banana, and citrus fruits also come in this category.

What vitamins are good for Trigeminal Neuralgia?

The development or occurrence of Trigeminal Neuralgia has its own reasons, one of which is the pressing down of the nerve by a blood vessel. The etiology is also related to the availability of the vitamins. The deficiency of vitamin B12 leads to Trigeminal Neuralgia. Hence, the treatment modalities also include the application of Vitamin B12 injections, which favor the good recovery of Trigeminal Neuralgia.

What are the alternatives to the treatment?

There are a few alternative treatments that are being explored for this condition. One such treatment is injecting glycerol injections at the base of the skull in order to damage the trigeminal nerve in the face. Balloon compression is also a treatment that can be used to damage the nerve sufficiently. Radiofrequency thermal lesioning can also be used for the same purpose. It damages the nerve fibers that are associated with pain.

Summary: Trigeminal Neuralgia is a syndrome related to the trigeminal nerve and characterized by severe episodes of unilateral facial pain. It usually gets better with the treatment in most cases while in some cases it subsides down itself. There are possible chances of recurrence which happens after a gap of the time period. Some of the preventive measures include intake of vitamin B12 rich food items as well as liquid and less chewable meals.

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Written ByDr. Arun Sharma MBBS,MS - General Surgery,MCh - Neuro SurgeryNeurology
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