Triggers:
Touch and movement trigger TGN. Thus, washing the affected area,
shaving, brushing, talking, smiling, eating, drinking, putting-up makeup, dental
prostheses, and even drafts (air currents) leads to TGN. It pains when you kiss or smile! Paroxym of
pain rarely occurs at night when the sufferer is asleep.
Causes:
Anything that harms trigeminal nerve (fifth cranial nerve, CN-V), may cause TGN, especially the anomalous intracranial vessels
compressing the trigeminal root. Aneurysms, tumours, multiple sclerosis, herpes
zoster, chronic meningeal inflammation, skull base malformation are some secondary causes of trigeminal neuralgia.
Investigations:
Most often, the diagnosis is clinical. MRI is justifiable for secondary
causes of TN.
Differential Diagnosis:
- Cluster headache
- Chronic paroxysmal hemicrania
- Cracked tooth syndrome
- Jabs and jolts syndrome
- Post‐herpetic neuralgia
- Giant cell arteritis (temporal arteritis)
- SUNCT (Short‐lasting, unilateral, neuralgiform headcahe with conjunctival injection and tearing)
Source: http://bja.oxfordjournals.org |
Treatment:
Trigeminal neuralgia treatment mainly comprises of pharmacological therapy; however, surgical procedures are also considered in some cases.
Medical:
Carbamazepine (Tegral, Teril) -
start with 100mg per oral, twice a day; maximum dose is 400mg six hourly.
Lamotrigine (Lamictal, Lamnet,
Lojin) - start with 25mg once or twice daily; increase slowly up to 250mg twice
daily.
Phenytoin (Dilantin)- 200-400mg
per oral, daily, before meals; maximum dose is 600mg per oral daily.
Gabapentin (Gaba, Gabix, Neurontin) - Start with
300mg once a day at day 1, twice a day at day 2 and thrice a day at day 3.
Usually, 300-600mg per oral, thrice a day; maximum dose is 2400mg per day.
Usually, it is given in addition to Carbamazepine. It is tried in those cases
which do not respond to conventional therapy or those suffering from multiple
sclerosis.
Pregabalin (Lyrica, Gabica,
Zeegap, Regab, Pegalin) - 50-100mg, per oral, thrice a day; may be increased up
to 600mg daily in 2-3 divided doses.
Baclofen (Lioresal)- start with
5mg per oral thrice daily; increase dose of 5mg at 3 days intervals; maximum dose
is 100mg per oral daily.
Surgical:
If drug treatment fails, surgery of
peripheral nerve, the trigeminal ganglion or the nerve root may be necessary. Microvascular
decompression is a surgical procedure where anomalous vessels are separated
from the trigeminal root. Other surgical procedures include gamma knife
radiosurgery, glycerol injection, balloon compression and radiofrequency
thermal lesioning.
Alternative Therapy:
Alternative therapy includes
acupuncture, biofeedback, vitamin therapy, nutritional therapy and electrical
stimulation of nerves.
Keywords: Trigeminal neuralgia, Facial pain, Tic doloureux, Microvascular decompression, Carbamazepine,Fifth cranial nerve, Trigeminal nerve,
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