What Are The Ways To Prevent Trigeminal Neuralgia & Does It Reoccur?

What Are The Ways To Prevent Trigeminal Neuralgia?

To prevent trigeminal neuralgia (TN) the exact cause of trigeminal neuralgia should be known. But still, the exact pathogenesis of trigeminal neuralgia is not known completely. There are some theories that trigeminal neuralgia occurs due to abnormalities in the afferent nerves of the trigeminal root or ganglion and damage to the axons can make the neurons hyperexcitable. Another theory is vascular compression by blood vessels near the trigeminal nerve root can press, damage or irritate the nerve.

Prevention is difficult without knowing the exact pathology or cause/s.

Studies have identified various triggering factors for trigeminal neuralgia such as:

  • Touching the face
  • Talking
  • Chewing
  • Eating
  • Tooth brushing
  • Shaving
  • Drinking
  • Swallowing
  • Washing the face
  • Drying the face
  • Jaw movement
  • Blowing the nose
  • Hot or cold food/ water

So, adjusting your triggering factor/s to some extent might reduce the attacks of trigeminal neuralgia after diagnosis. However, not all triggering factors can be adjusted as most of these are normal day to day activities.

  • Avoid food that is too hot or too cold
  • Avoid cold air
  • Have soft foods
  • Wash your face with lukewarm water
  • Use cotton pads to wash your face
  • Chew your food and swallow slowly
  • If brushing your teeth triggers an attack gently rinse your mouth after eating

After you identify an action as a triggering factor try to change its pace or way of doing it and see if that prevents a trigeminal neuralgia attack. (1)

Does Trigeminal Neuralgia Recur?

The first-line treatment for trigeminal neuralgia is medical therapy with drugs such as anticonvulsants and antispasmodic drugs. The success rate is about 80-90%. However, tolerance occurs and patients need higher doses and experience side effects so, many discontinue drugs and go for surgical options. The surgical options are microvascular decompression (MVD), radiosurgery and radiofrequency lesioning.

Trigeminal neuralgia recurs with even after surgical operation, no surgical option guarantee 100% success, there are several case studies on this matter.

A study performed an electronic search from 1988 to 1998 on cases treated with MVD due to veins. There were 393 patients and 122 (31%) patients complained of recurrence and 32 out of this recurrent patients have undergone reoperation. According to their findings, recurrent trigeminal neuralgia was seen more in females, the age ranged from 15-80 years with a predominance in the 7th decade. 75% of the recurrent patients experienced recurrence within one year after the 1st operation. During the second MVD operation, new veins were seen around the root of the trigeminal nerve in 87.5% of patients thus, the cause of the recurrence was the regrowth and development of novel veins. After the second operation pain was improved in 81.3% of patients.

This is another study done on recurrent trigeminal neuralgia after MVD. Initially, 82 patients underwent MVD with interposing Teflon and 14 (17.1%) patients had a recurrence and 6 patients with severe symptoms underwent reoperation. For all 6 cases, a different technique was used (sling retraction) as adhesion from the interposed Teflon was the reason for the recurrence in all cases. All 6 cases improved and have not experienced pain for the follow-up period of 2 years. The study concludes that MVD with interposing technique could cause recurrence therefore, to use sling retraction even for the initial MVD operation. (2) (3) (4) (5)

Conclusion

Studies have identified some triggering factors for trigeminal neuralgia such as: Gently touching the face, talking, chewing, tooth brushing, washing the face, eating, swallowing, drinking, drying the face, shaving, jaw movement, blowing the nose, and hot or cold food/ water. After you identify an action as a triggering factor try to change its pace or way of doing it and see if that prevents a trigeminal neuralgia attack. The first-line treatment for trigeminal neuralgia is drugs but due to tolerance and side effects then patients move onto surgical options. Even after surgical therapy recurrence can occur. According to one study, recurrent trigeminal neuralgia was seen more in females, with a predominance in the 7th decade and the majority of cases occurred within the first year. The recurrence depends on the cause of trigeminal neuralgia, treatment method, and technique used and the experience of the doctor. No treatment options guarantee 100% success

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