Trigeminal Neuralgia

Question: Trigeminal neuralgia: can it involve a constant pain instead of a fleeting pain? Classic trigeminal neuralgia involves a fleeting pain that is often triggered by an external stimulus. The cause is often found to be a blood vessel pressing on a nerve. Can that same situation (a blood vessel pressing on a nerve) cause a constant pain that is not triggered by an external stimulus? If so, is the blood vessel always apparent on an MRI? Or might an MRI miss it? Thanks for all replies.

Answer: Yes, TN can cause constant pain. When it does, it's usually classified as "atypical trigeminal neuralgia." If a blood vessel is pressing on the nerve, an MRI ordered to focus in tightly on the trigeminal nerve ought to catch it, but sometimes the cause of trigeminal neuralgia isn't as readily apparent as a blood vessel pressing on a nerve. Sometimes (as in my case) there's no visible cause at all to explain why the nerve keeps firing. There's a useful breakdown of the various types of TN and related facial pain problems here: http://www.umanitoba.ca/cranial_nerves/trigeminal_neuralgia/manuscript/types.html (Although bear in mind while reading it that this website is focused on MVD, so it tends to overstate both the probability of a blood vessel pushing on a nerve as the evident cause *and* the efficacy of the MVD operation as a cure for TN. Nonetheless, if you can overlook that, it's still a pretty decent breakdown.)

Question: Can a toothache cause Trigeminal Neuralgia? I know Trigeminal Neuralgia can cause a "toothache", but can a toothache cause a trigeminal neuralgia flare up in someone predisposed to them? Please cite sources.

Answer: Yes it is possible especially those teeth supplied by the trigeminal nerve

Question: Does anyone have Neuralgia or Trigeminal Neuralgia and what pain relief and medication are you taking? Hi, I have Trigeminal Neuralgia and am not fining my pain relief effective or my medication but particularly pain relief i am taking up to 450mg of Codeine a day and Tramadol (not at the same time). It is not even touching the pain! Any advise from others who have this or from professionals who have come across this sort of problem? Any advise at all would be welcome even if it seems really obvious! Thanks, C x

Answer: Hi. I'm on Tegretol right now for my TN, and I also have oxycodone for breakthrough pain. The Tegretol isn't working for me at the moment, so I find I'm taking far more oxycodone that I'd like. I'm not in a very good place right now, pain-wise. I have an appointment with my neurologist coming up, but I'm sort of dreading it. I suspect he's going to want to titrate my dosage of Tegretol upwards, and I'm already having a really hard time with the side-effects. I think that it may be time for us to try a different anti-convulsant, but if we do that, then I'm going to need a lot more pain-killers to help me through the transition period, and even with that help, it's still going to be pretty awful. Are you on an anti-convulsant, like Tegretol, neurontin, or Lyrica? They've only been partially successful for me, but I know they've helped a lot of TN sufferers to live very nearly pain-free. If the one you're on isn't working for you, it may be time to try another and see if it does a better job. There are quite a few of them to choose from, and everybody seems to react differently to them, so it's definitely worth checking to see if another drug might be more effective for you. Pain-killers usually don't work on neuralgia nearly as well as they do on, for example, post-operative pain or muscle pain. For me, they don't stop the pain altogether; they just knock it down a few notches on the pain chart. But those few notches can make such a huge difference! I'm sorry that they're not even doing that much for you. Have you been to see a pain management specialist, or gone to a pain management clinic? If not, I very much recommend it. They're experienced in dealing with these problems, and might be able to find a pain management regime that works better for you. ETA: A good place to talk to lots of other people who suffer from this monstrous problem are the TNA Forums here: http://www.fpa-support.org/forumlanding2.html You have to sign up first, but it doesn't cost anything and they won't spam you. The people there are friendly, and even just lurking there can make you feel a lot less alone. It did for me, anyway.

Question: What caused my trigeminal neuralgia? I have trigeminal neuralgia, an agonising condition involving pressure on a nerve in my face. I am on epilepsy drugs but am tired and forgetful and still in pain. I really feel my life, which until last year was perfectly happy, isn't worth living. I have no idea why I suddenly got this. I am only 25. It first occured at quite a stressful time. I have also had root canal treatment on the same side of my face. Of course the dentist denies all involvement, but I can't help thinking this could have triggered it. Any ideas? Or remedies?

Answer: My mother has suffered from this on and off over the past few years, and I wouldn't wish it on my worst enemy. So I feel really sorry for you. She has had some really effective tablets. I'll find out what they are, but when she was referred to see a consultant, he gave her an injection which gave immediate relief and seemed to have quite a lasting effect. She was also told that if the pain got unbearable again, she could phone up and have another injection. It's worth asking about this, and seeing if you could have the same back up for any future attacks. Good luck.

Question: Do you need surgery to remove Trigeminal Neuralgia? What can Trigeminal Neuralgia do to you? I have recently found out a family member has Trigeminal Neuralgia. I do not know much about this, or what could happed to her. If anyone could explain, I would be very happy. Thank you very much. :)

Answer: The trigeminal nerve carries sensation from your face to your brain. In trigeminal neuralgia the nerve's function is disrupted. Usually, the problem is contact between a normal artery or vein and the trigeminal nerve, at the base of your brain. This contact puts pressure on the nerve and causes it to malfunction. Trigeminal neuralgia can occur as a result of aging, or it can be related to multiple sclerosis or a similar disorder that damages the myelin sheath protecting certain nerves. Less commonly, trigeminal neuralgia can be caused by a tumor compressing the trigeminal nerve. In other cases, a cause cannot be found. A variety of triggers may set off the pain of trigeminal neuralgia, including: Shaving, Stroking your face, Eating , Drinking, Brushing your teeth, Talking, Putting on makeup, Encountering a breeze, or Smiling. It is treated with medications first, anticonvulsant agents, then antispasticity agents. If that doesn't work then it is treated with alcohol injection. Finally, if the previous therapies fail, they might try glycerol injections. If all fails then one of 4 surgical techniques, or radiation or a combination of therapies might be tried. Some other methods for controlling the symptoms are: Acupuncture, Biofeedback, Vitamin therapy, Nutritional therapy, and Electrical stimulation of nerves. For additional infor mation and support try this site: http://www.fpa-support.org/

Question: For those with trigeminal neuralgia or who know a lot about it? My mother experiences a lot of pain in both sides of her face. While most times you can't see any facial redness sometimes her face gets very red and almost looks burnt. She hads the pain all the time, don't in shocks...such as those described in trigeminal neuralgia. She is currently going to the neurologist and has tons of test run. The doctor is pretty much doing a trial and error as far as meds go. They are treating her fortrigeminal nueralgia, but from what I read it doesn't seem quite the same as what she is experiencing. Do people with TN every have constant pain on both sides? I can not find any other conditions that even come close to describing what she has besides TN. Thanks to anyone with advice.

Answer: i think it is normal to have pain on both sides but if she is being treated and it is not working maybe she could try other doctor

Question: Ways to relieve the pain of Trigeminal Neuralgia? I have a disorder known as trigeminal neuralgia... it is extremely painful! I was wondering if anyone knows of ways to relieve the pain? I currently use anti-convulsants and 'tons' of Tylenol (with doctor's OK, that is!)Any suggestions would be greatly appreciated, thanks!

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Question: Top docs in country for treatment of trigeminal neuralgia? Can anyone direct me to the top doctors/hospitals in the country for the treatment of trigeminal neuralgia? (I actually have atypical trigeminal neuralgia, if that matters.) Thanks for all replies. I primarily need to see a doc in the U.S.A. about MVD. Thank you.

Answer: Are you looking for a neurosurgeon to perform an MVD or Gamma Knife surgery, or are you looking for a neurology department or pain management clinic for less intrusive forms of treatment? Different treatments have different specialists. The Trigeminal Neuralgia Association maintains a list of providers here: http://www.fpa-support.org/providers/index.html You might also get some good info from the people on the forums, here: http://www.fpa-support.org/forumlanding2.html You do have to sign up first to read the forums, but it's free and they don't spam you. ETA: I don't really have a list of MVD names for you, sorry. I do know that Dr. Peter Jannetta is the big, big name in MVD: he's the man who pioneered the surgery and as far as I know, he still accepts patients. He's in Pennsylvania, I believe. Dr. Kim Burchiel at OHSU in Portland, Oregon, has a good rep -- but I really only know that because I live in Portland. Since you seem to know exactly what you're looking for, I would definitely recommend asking the folks on the forum I linked you to above. A lot of them have had the MVD procedure -- some with amazing results, and some with less satisfying results -- and I'll bet they'd be willing to give you a list not only of good neurosurgeons, but also of those you might wish to avoid. Sorry I couldn't be of more help.

Question: Is Migraineous Neuralgia a component of Trigeminal Neuralgia? Are "Cluster Headaches" or Migraineous Neuralgia one of the three components of Trigeminal Neuralgia?

Answer: Trust me when i say if you suffered from this suicide disease you would know about it. I've had it for 3 years now and when I mean its a whole new level of pain as in sometimes curling in a ball and crying in the middle of the shops, i really do mean it. If you had it you would know about it.

Question: My friend has atypical trigeminal neuralgia is there anything that can be done? atypical trigeminal neuralgia any surgeries, or medication or excersie to alleviate pain he has tried some drugs but nothing to get rid of the pain and i feel bad because i cant relate to this

Answer: Yes. A top chiropractor. A very good choice is one that specializes in upper cervical methods...

Question: trigeminal neuralgia? I have had severe facial pain and shooting pain through my left ear. Dr. has been treating me for trigeminal neuralgia. Yesterday I woke up and couldn't and still can't open my mouth more than an inch. The pain can be so bad I can't function. Does anyone know much about this and could it be related to an old filling in my tooth or other dental problem????

Answer: TN is not usually characterized by the inability to open your mouth, it's usually a sudden, severe, electric shock-like or stabbing pain typically felt on one side of the jaw or cheek. The attacks of pain, which generally last several seconds and may be repeated one after the other, may be triggered by talking, brushing teeth, touching the face, chewing or swallowing. Is your doctor sure that's what you have? It almost sounds more like TMJ. TMJ / TMD, or temporomandibular joint disorder, is a term used to describe a group of symptoms including headaches; facial pain; jaw pain; sore, chipped, broken, or worn teeth, clicking or popping in the jaw, and limited jaw movement. In many cases people suffering from TMJ / TMD report chronic pain in the jaw, teeth, face, head, neck, shoulders, or back, or any combination of these areas. Snoring, grinding of teeth, frequent ear infections and restricted airway are other problems associated with TMJ / TMD. This group of symptoms is also referred to as MPD (myofascial pain dysfunction) and craniomandibular dysfunction. See your doctor and/or dentist and get a definative diagnosis.

Question: Do you have trigeminal neuralgia that affects both sides of your face? I was diagnosed with Trigeminal Neuralgia over the summer...it was on my left side but I believe I have had pain before on my right side. The "spasms" started again three days ago, but on my right side now...I'm wondering if I've been misiagnosed or if I am one of the few with TN that is affected on both sides...

Answer: I don't have Trigeminal Neuralgia but I used to know of someone that did. It is possible that you could be one that has it on both sides, but I would recommend getting back in touch with your neurologist to let them know what's going on so that they can evaluate the situation further.

Question: Can trigeminal neuralgia affect decision making? My wife( very smart by the way) was diagnosed 6 years ago. Her decision making is not good concerning daily, weekly, monthly tasks. In other words she forgets alot.

Answer: Is she on Tegretol, Neurontin, or another anti-convulsant for the TN? If so, then that's probably what's doing it to her, more than the TN itself. Those drugs are *notorious* for wreaking holy havoc with ones memory. Check out any trigeminal neuralgia support group online, and you'll see lots of people complaining and commiserating with each other about the memory loss and "brain fog" caused by these drugs. I also have TN, and I've been having terrible memory problems as well, especially now that I've had to go to a higher dose to control the pain. I also feel "dumbed down" a lot of the time, which is scary and frustrating, like I've suddenly stumbled into the lead role of "Flowers For Algernon." Brrrrr. What's helped me a lot is to start keeping one of those Day Runner type notebooks (the kind with not only weekly and monthly calendar sheets, but also phone/address and "note" sheets in it) on me at all times, and to write *everything* down in it promptly -- even things I think I'll be able to remember. It makes me feel a little silly sometimes, since I've been out of work and so don't really feel like I should need one of these big old yuppified corporate day planners, but it's really been a lifesaver for me. Your wife could probably also use a lot of emotional support. The 'dumbing down' effect can be really morale-destroying, even worse in some ways than the pain. But I'm sure you know that. :)

Question: Is trigeminal neuralgia curable or is it just something that has to be treated for the rest of a person life? Trigeinal Neuralgia is a disfunction in the brain nerve and causes ( to me) severe pain on my face that is unbearable for a limited amount of time. The pain comes and goes. Sometimes it is gone for several months then it will come back strong and last a short period or a long period of time. I am in the military but they won't relate this to being cause from banging my head on the trucks whenever I was driving or on the passenger side while I was in Iraq on those rough road conditions. I am currently taking a heavy dosage of Gabopentin to try to stop the pain from occuring often.

Answer: If you type in "trigeminal neuralgia surgery" in Yahoo! search, you will come up with some potentially useful information. Sometimes medications will help, but they may not be a cure-all. There is a procedure called microvascular decompression, where a tiny piece of felt is placed between the trigeminal nerve and underlying vascular structures, relieving the compression often responsible for the neuralgia. One website with information about this is: www.neurosurgery.pitt.edu/minc/cranial…

Question: Why are electrical impulses in Trigeminal Neuralgia plainful, and not in epilepsy? I need an answer from someone who has really studied this.

Answer: Trigeminal nerve is a sensory nerve. In the area supplied by it, pain-sensitivity is higher in cases of trigeminal neuralgia. That is the reason the stimulation is painful. In epilepsy, motor nervous system is involved, pain is not the issue here. Hope I helped. Good luck!

Question: What treatments have you had for trigeminal neuralgia? I have facial pain that is triggered by hot,cold,and pressure. It has gotten so bad that even if i touch my face it triggers pain. I just need to know what treatments have been suggested for others.

Answer: What Is It? Trigeminal neuralgia, also known as tic douloureux, is a disorder of one of the nerves in the face that causes brief, shock-like pain, usually on one side of the jaw, cheek or mouth. This disorder involves the fifth cranial (trigeminal) nerve, which is responsible for sending impulses to the brain from the face, jaw, gums, forehead and the area around the eyes. The cause of trigeminal neuralgia is not always known. The condition can occur as a result of multiple sclerosis, a brain tumor or another brain disease, such as an aneurysm. However, in 90% of cases, there is no serious brain disease. One widely held theory is that the problem is caused by an artery pressing on the trigeminal nerve where it exits the brain. A computed tomography (CT) scan or magnetic resonance imaging (MRI) should be done to check for a brain lesion. Trigeminal neuralgia is rarely seen in people under the age of 50. When it does occur in younger people, the cause is more likely to be a tumor, aneurysm or multiple sclerosis. Symptoms Trigeminal neuralgia is characterized by a sudden, severe, electric-shock-like attack of pain on one side of the face. The pain generally lasts for several seconds to a minute and then disappears. Shaving, showering, eating, speaking or even exposure to wind can trigger a painful episode, and patients often protect the trigger zone. Trigger zones usually are found around the cheek, nose, lips or inside the mouth. When the trigger zone is inside the mouth, it often is confused with a toothache. Diagnosis Trigeminal neuralgia is diagnosed based on the symptoms, including a history of characteristic pain along the trigeminal nerve. An MRI scan should be done to look for other possible conditions, such as a tumor, aneurysm or multiple sclerosis. Expected Duration Trigeminal neuralgia attacks last for several seconds to a minute and then totally disappear, but they may be repeated one after another. The number of attacks can vary from one or two per day to several per minute throughout the day. Episodes of attacks can last for days, weeks or months at a time and then disappear for extended periods of time. People with severe trigeminal neuralgia can be significantly disabled by the attacks. Treatment A number of drugs can help to prevent attacks, including oxcarbazepine (Trileptal), carbamazepine (Tegretol, Atretol, Carbatrol, Epitol), gabapentin (Neurontin) and phenytoin (Dilantin and other brand names). However, these drugs have the potential for serious side effects, and a dentist or physician should monitor their use. These medications sometimes are used in combination with other drugs, such as baclofen (Lioresal), to help achieve pain relief. Some of these medications require blood tests while you are taking them to monitor liver function and the level of the drug in your blood. If medication fails to provide relief, your doctor may refer you to a neurosurgeon to talk about surgical treatment options. When To Call A Professional If you are experiencing pain characteristic of trigeminal neuralgia (electric-shock-like pain on one side of the jaw or cheek), you should see your dentist or physician immediately. Prognosis Trigeminal neuralgia is not a life-threatening condition unless it is caused by a tumor, aneurysm or other brain disease. Yet, the condition can be incapacitating. However, most cases can be controlled with medication, and/or surgery. Additional Info National Institute of Neurological Disorders and Stroke P.O. Box 5801 Bethesda, MD 20824 Phone: (301) 496-5751 http://www.ninds.nih.gov/