Tuesday, September 30, 2003
My 26-year-old daughter was diagnosed with trigeminal neuralgia after suffering for months with explosive, migraine-type headaches. What is it? What causes it? Is it a lifelong condition? She was prescribed an anti-seizure medication. Is that the best treatment and isn't prolonged exposure to anti-seizure medications dangerous?
The trigeminal nerve is one of the nerves of the head and is so named because it has three major branches. Sensation on the skin of the face and the upper and lower teeth are provided by the trigeminal nerve. Neuralgia is the word for nerve pain. Trigeminal neuralgia is severe, sudden bursts of pain in one or more branches of the trigeminal nerve.
TN is more common in women and usually occurs in the fifth and sixth decades of life. Very often, there is no known cause. When TN develops in younger people, an underlying disease such as multiple sclerosis or a brain tumor may be the cause. Before your daughter is diagnosed with TN, other causes of facial pain must be ruled out.
The pain of TN can be severe and is frequently described as sharp, stabbing, burning or shooting. The jaw, or the jaw and cheek, on one side of the face are common areas of pain. Episodes of pain usually last for less than two minutes and are often provoked by stimuli such as lightly touching certain parts of the face or chewing or talking.
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This is a chronic disease, with periods of exacerbations and remissions. Although TN is not a fatal disease, if left untreated, it can significantly disrupt a person's life.
Medical management is aimed at preventing pain. A large percent of people respond favorably to drug therapy. Common drugs prescribed are carbamazepine, baclofen and phenytoin. Newer, potentially safer drugs include lamotrigine and topiramate. With the exception of baclofen, these are all anti-seizure medications.
Carbamazepine is the drug of choice. Common side-effects, such as nausea, loss of appetite, drowsiness and slurred speech, often subside after a few weeks. Less common side effects include bone marrow suppression and liver injury. Blood tests are performed regularly to monitor for the more serious side effects. After about three years, one-fourth of patients treated with carbamazepine will no longer get relief of pain or will develop side effects significant enough to have to stop the medication.
Capsaicin cream, available over-the-counter, has effectively reduced pain in some people with TN. Be sure not to apply the cream on the eyelid or near the eye.
Injection therapy or surgery is sometimes necessary for people who do
not respond to or do not tolerate medication therapy.
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