Trigeminal neuralgia also is known by another name of tic douloureux is a distinct syndrome of facial pain. It occurs due to the pain sensation in the fifth cranial nerve or its components known as the trigeminal nerve. The trigeminal nerve has three components: ophthalmic nerve, maxillary nerve, and mandibular nerve. Trigeminal neuralgia is a sharp and stabbing pain in the area supplied by the trigeminal nerve and it appears in bouts rather than a continuous pain sometimes described as shooting pain. It is accompanied by facial spasm and tics in the face. It sometimes radiates to other parts of a scalp and also is accompanied by headaches, blurring vision, eye ache, etc.
What Is The Best Treatment For Trigeminal Neuralgia?
Most of the cases present to the clinic after the age of 50 years and can be treated on an outpatient basis with requiring only medical intervention. The first-line management includes medical treatment only and most of the cases are either relieved by short term medication or sometimes may include a long term medical treatment. Various drugs and medications are used with a variety ranging from the antiepileptic drugs to antidepressants and skeletal muscle relaxants.(1)
Drugs used in relieving the neuropathic pain are usually belonging to antiepileptics like Gabapentin, pregabalin, carbamazepine, oxcarbazepine, valproate, lamotrigine, phenytoin, topiramate, etc. These drugs have a very high success rate with carbamazepine and sodium valproate being especially effective and beneficial in the trigeminal neuralgia treatment. Another group of drugs including tricyclic antidepressants likes amitriptyline; nortriptyline can be used in the treatment.
Sometimes skeletal muscle relaxants like baclofen, botulinum toxin are also used for relieving the symptoms caused due to persistent spasm of the facial muscles. Botulinum toxin acts on the neuromuscular junction of the muscles and inhibits the release of neurotransmitter from it resulting in non-contraction of the muscles. It is usually used when symptoms of trigeminal neuralgia become very severe and intractable.
Treatment of trigeminal neuralgia usually lasts for 6-12 months and then the patient can choose to either continue treatment for preventing the disease in the future or stop the treatment until any further need is felt for it. After only such short treatment the disease can go into remission automatically by itself. Sometimes more than one drug can be required because it may become severe enough to be not relieved by single medication. It may require starting the treatment again in the future but usually, it is not required.
Trigeminal neuralgia also has surgical treatment in medically resistant cases. Alcohol blockage of peripheral nerves and roots of the trigeminal nerve are the treatment of the past and are not used nowadays due to the vast amount of side effects and very less selectivity.(1)
Best Treatment For The Pain Of Trigeminal Neuralgia?
A best and most efficient way to deal with trigeminal neuralgia is medical treatment because of its effective control and short term treatment. Surgery is also favorable in patients who do not want to be on medication and want a simple and immediate solution for the disorder because it is a single step treatment and does not require any further intervention and patient can live disease-free life thereafter. Most common surgical treatment includes vascular decompression surgeries which are most effective because of its association with vascular malformations up to 36%. Gamma knife surgery is one of the effective surgeries for the treatment. These are effective for about 15-20 years and the patient is immediately symptom-free and remains the same way.
It is a curable disease with a very good success rate and prognosis. Medical treatment has a very high success rate with generally a single medicine effective for the treatment. Surgical treatment can become necessary in few of the intractable cases with high recurrence. It may get resolved in a few months to years but sometimes it may persist for even lifelong especially in the cases associated with other degenerative or autoimmune diseases. It is necessary to identify the symptoms early to get good treatment and prevention of the complications.
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