Trauma and Trigeminal Neuralgia
Trigeminal neuralgia involves extreme pain in the face caused by damage or inflammation to the trigeminal nerve or the fifth cranial nerve. There are three branches to the trigeminal nerve, any one of which can be affected. The trigeminal nerve breaks off into an ophthalmic nerve, which innervates sensation around the eye, the maxillary nerve, which innervates sensation around the cheek and maxillary area, and the mandibular nerve, which regulates sensation of the lower jaw area.
In cases of traumatic trigeminal nerve injury, any one of the branches can be affected but the pain is usually on one side of the face.
A motor vehicle accident that causes damage to the skull, brain or face can contribute to injury to the trigeminal nerve, leading to severe pain. People who suffer from this condition will often report the sudden onset of stabbing pain on one side of the face in the ophthalmic, maxillary, or mandibular areas. The pain is usually intermittent but can be steady, depending on the nature of the injury. When the pain is intermittent, it can last just a few seconds up to a couple of minutes. People have been known to have many hundreds of attacks of trigeminal neuralgia per day. In between sudden attacks, the pain can be dull, aching, or the patient can experience numbing of the face.
The pain of trigeminal neuralgia can be triggered by seemingly innocuous things, such as touching the face gently, brushing the teeth, eating, talking, drinking, and washing the face or being exposed to cold air blowing on the face. While it is technically not a fatal disease, the pain can become so intractable that the patient commits suicide in order to relieve the intense pain.
Causes of Trigeminal Neuralgia
Trigeminal neuralgia can be caused by a compression injury to the trigeminal nerve as it exits the brain through a small hole in the skull. A fracture in this area from a fall or motor vehicle accident can trigger swelling that damages the trigeminal nerve at its root. Soft tissue trauma can affect just one or two of the branches of the trigeminal nerve, sparing some of the face from the pain. Trigeminal neuralgia can also result from inflammation of the nerve or by the presence of a blood vessel that swells and compresses the nearby nerve. A brain injury secondary to trauma can damage the trigeminal nucleus in the brain, causing hyperactivity of the nerve due to central nervous system injury.
Diagnosing Trigeminal Neuralgia
Trigeminal neuralgia can be diagnosed by taking a careful history and physical examination of the facial area. Patients are usually able to describe the pain as well as the area of the face affected by pain. An MRI exam can be done to see the exit point of the trigeminal nerve and to see if there is an enlarged vessel or a fracture that is pinching off the nerve as it exits the skull. MRI scans are not always helpful but can help decide if the neuralgia pain is due to non-traumatic causes such as multiple sclerosis or tumors near the nerve. Even if the MRI test is normal, there can be damage to the nerve that is just not detectable. Trigeminal neuralgia is never psychosomatic nor is it caused by mental illnesses such as depression or anxiety.
Treatment of Trigeminal Neuralgia
There are medications that can help those with trigeminal neuralgia while others can get better through alternative medicine strategies or surgery. Some patients get better with medications usually reserved for seizures because the medication slows the firing of the nerve. Older antidepressants such as tricyclic antidepressant medications will help relieve the pain by acting on the brain’s pain receptors. Nonsteroidal anti-inflammatory medications or opioid medications have been found to be useful in some situations although they do not often eliminate the pain.
Surgery is reserved for those cases in which medications do not help. One surgical procedure often used in this situation is called a “rhizotomy”, which is a procedure in which nerve endings are blocked by freezing or burning the ends of the nerve, reducing the firing of the nerve impulses. Things like TENS unit stimulation and acupuncture have been found to be helpful in some cases of trigeminal neuralgia. Massage can also help some individuals with this type of pain. Biofeedback can control the perception of pain when other treatment methods have failed.
A recent medical study on post-traumatic trigeminal neuralgia showed that up to forty percent of cases of the disease are secondary to trauma. During treatment using the various treatment methods discussed above, almost half of all patients experienced a reasonable reduction in pain at about six months post-injury. Slightly more than half of all patients were able to feel better after a year following their injury. Younger patients seemed to recover better and faster with people over the age of sixty years having the most trouble with ongoing pain after a year post-injury.
While trigeminal neuralgia is relatively rare, it causes significant disability in those who suffer from it. Treatment is available yet almost half of all patients are still suffering from significant and debilitating pain after a year post-injury. The treatment modalities include surgical and non-surgical methods. Sometimes many different treatment modalities need to be tried in order to find some kind of relief from this often devastating condition. Attacks of trigeminal neuralgia tend to come and go so that, even if pain is relieved for a period of time, the symptoms tend to come back and last for many years.
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