Trigeminal neuralgia, also known as tic douloureux, is a disorder of a nerve in the face called the trigeminal nerve or fifth cranial nerve. These nerves are responsible for detecting touch, pain, temperature and pressure sensations in the face area. People who have trigeminal neuralgia usually have episodes of sudden, intense facial pain. This pain can occur almost anywhere between the jaw and forehead.
The first treatment for trigeminal neuralgia usually is carbamazepine (Tegretol and others). Carbamazepine is an anticonvulsant medication that decreases the ability of the trigeminal nerve to fire off the nerve impulses that cause facial pain.
Some of these medications carry the risk of unpleasant side effects, including drowsiness, liver problems, blood disorders, nausea and dizziness. For this reason, people taking any of these medications may be monitored with frequent follow-up visits and periodic blood tests. After a few pain-free months, your doctor may attempt to decrease the dose of the medication gradually or discontinue it. This is done to limit the risk of side effects and to determine whether your trigeminal neuralgia has gone away on its own.
If medication does not stop your pain or if you cannot tolerate the side effects of medication, then your doctor may suggest one of the following treatment options:
Rhizolysis —Part of the trigeminal nerve is inactivated temporarily by using one of the following methods: a heated probe, an injection of the chemical glycerol or a tiny balloon that is inflated near the nerve to compress it.
Stereotactic radiosurgery — This form of radiation therapy uses a linear accelerator or a gamma knife to inactivate part of the trigeminal nerve. After your head is positioned carefully in a special head frame, many tiny beams of radiation are aimed precisely at the part of the trigeminal nerve that must be inactivated.
Microvascular decompression of the trigeminal nerve — In this delicate surgical procedure, a surgeon carefully repositions the blood vessel that is pressing on your trigeminal nerve near your brain.
Besides standard treatment, complementary and alternative treatments for trigeminal neuralgia such as acupuncture, biofeedback, nutritional therapy and electrical stimulation of nerves may help reduce the symptoms.
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