Trigeminal neuralgia (TN) is one of the most common forms of mouth pain. In patients with this condition, neurological findings may be entirely normal, but the pain continues despite initial success with medication. Very often, patients experience breakthrough pain even when medicated, resulting in the need for more and more medication to receive needed relief. For some patients, pain continues despite having a tooth pulled. TN was first recognised in 1900 as a condition treated by complete ablation of the gasserian ganglion.
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According to Manish Singh, MD of Hahnemann University Hospital, trigeminal neuralgia is a painful condition of the mouth and the cranial nerve V. TN may appear as a migraine cluster headache and initially be diagnosed as a common toothache or even TMJ. However, upon treatment for these conditions, the patient may not receive relief. TN is most common in women, appearing twice as often. It is also a condition that has a short duration, with onset older than 50.
According to Singh, the primary symptoms of trigeminal neuralgia are transitory sharp pains that appear on the side of the face and head. This may appear to be similar to a cluster headache or migraine pain. Other symptoms include intermittent pain that may disappear for long periods of time between attacks. After the attack, facial numbness is not usually present, nor are there usually attacks while the patient is sleeping.
Compression of the cranial nerve V is the primary cause of trigeminal neuralgia, states Singh. However, many other conditions exist concurrently with TN. Examples include: glossopharyngeal neuralgia (GN) and occipital neuralgia (ON) syndromes. These are two nerve syndromes that result in pain in the face and mouth areas of the head. Other conditions such as multiple sclerosis can also have an effect on facial pain.
According to Singh, approximately 75 per cent of patients with TN are able to receive relief with medical therapy. Since this is a condition that happens in older individuals, he suggests that medical treatment is the logical and appropriate initial therapy for TN. Many individuals opt to discontinue medical therapy after the first year of treatments because the condition often goes into remission. However, many people decide to continue treatments later when the condition returns. A wide variety of medications have proven effective in the treatment of TN, including gabapentin and Lamotrignene, both anti-seizure medications.
Singh suggests that over time medication treatment begins to lose its effectiveness. As a result patients may begin to experience breakthrough pain. Surgery may be the next best option. One suggestion is gamma knife surgery. This particular surgical intervention is especially effective in the treatment of trigeminal neuralgia. However, surgical intervention is not effective for individuals who have TN secondary to multiple sclerosis.
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