Inside the Battle Against Trigeminal Neuralgia

Striking roughly 1 in 15,000 individuals, trigeminal neuralgia is a condition with a “death wish” due to its excruciating, electric shock-like pain that can push sufferers to the brink of despair. In such circumstances, when trigeminal neuralgia strikes, individuals often endure excruciating facial pain described as jolting, stabbing, or resembling electric shocks concentrated on one side of the face. Seemingly mundane activities like brushing teeth, shaving, talking, or feeling a cool breeze can unexpectedly trigger these intense pain episodes. The severity of the pain can disrupt daily activities and sleep, fostering feelings of depression and anxiety. In some instances, the pain may persist as a constant burning sensation rather than manifesting as sharp, episodic bursts.

1. Age and Occurrence: Although TN can occur at any age, it predominantly affects individuals over 50 years old and is very rare among minors. The incidence of TN increases significantly with age.
2. Misleading Pain-Free Periods: TN can present periods of remission lasting from weeks to years, creating a false sense of security. These pain-free intervals can complicate the diagnosis and make the condition unpredictable.
3. Trigger Zones and Hypersensitivity: Certain facial areas become hypersensitive in TN patients. Even a light touch can trigger an attack, making everyday interactions potentially painful.
4. Common Misdiagnosis: TN pain often mimics a severe toothache, leading many to seek dental treatment initially. However, unlike a toothache, TN pain is sharper, spans a broader area of the face, and does not respond to dental treatments.
5. Underlying Causes: The exact cause of TN is often unclear. The prevailing theory suggests that compression of the trigeminal nerve by blood vessels or tumors disrupts its normal function, causing it to send erroneous pain signals. Conditions like multiple sclerosis may also contribute to TN.
6. Importance of Medical Attention: Prompt medical attention is crucial when experiencing the intense pain characteristic of TN. A thorough evaluation by a healthcare professional is essential to diagnose the condition accurately and recommend appropriate treatment.
7. Diagnostic Procedures: Diagnosis primarily involves a detailed account of the pain, its location, and triggers. Medical history is crucial, and imaging tests like MRI scans help rule out other causes and identify nerve compressions. Additional tests may sometimes be required.
8. Treatment and Management: The primary goal in TN treatment is pain relief and prevention of future episodes. A multifaceted approach is common:
   • Medications: Anticonvulsants are often the first line of defense, stabilizing abnormal nerve activity.
   • Nerve Blocks: Involves direct injections of anesthetics or steroids into the trigeminal nerve for temporary relief.
   • Surgical Options: Minimally invasive surgeries may be considered when medication and nerve blocks are ineffective, aiming to disrupt specific pain fibers in the nerve.
   • Home Remedies: While not cures, some find temporary relief with heat or ice packs, but these should be discussed with a healthcare provider to avoid counteracting prescribed treatments.

Dr. Swaroop Gopal P, Group Director Aster International Institute of Neuroscience, Aster Whitefield Hospital, Bangalore.