- 21 Mar, 2023
- Dr. Arun Rajeswaran
- No comment
What are the common triggers of trigeminal neuralgia and how to avoid surgery?
Trigeminal neuralgia is a debilitating condition that causes sudden and intense facial pain. It is often referred to as the “suicide disease” due to the severity of its pain. The pain is usually felt in the cheekbone, nose, upper lip, and teeth, but can affect any part of the mouth. Understanding the common triggers and available non-surgical treatments can help ease the stress associated with trigeminal neuralgia.
Common Triggers
- Brushing teeth
- Talking
- Drinking
- Eating
- Touching the face
- Applying makeup
- Smiling
- Shaving
- Washing the face
Non-Surgical Treatments
Avoidance of Triggers
One of the simplest ways to alleviate pain due to trigeminal neuralgia is to avoid triggers that bring on pain attacks. Paying attention to what triggers your pain can help you minimize it in the future.
Medical Therapy
Another non-surgical option for treating trigeminal neuralgia is medical therapy. Medications such as antidepressants, antiseizure drugs, and muscle relaxers can help prevent pain attacks. However, not all patients respond to these medications, and their effect tends to decrease over time.
Radiosurgery
Gamma Knife Radiosurgery is a minimally invasive procedure that uses radiation therapy to treat trigeminal neuralgia. It is often used when other treatments have failed to provide relief. However, it is important to note that radiosurgery has the lowest success rate and the highest reoccurrence rate among the treatment options. It is reserved for older patients with comorbidities and is not suitable for surgery.
It is important to remember that trigeminal neuralgia treatment is highly individualized and what works for one person may not work for another. If you are experiencing severe and prolonged facial pain, it is best to consult a Neurosurgeon to determine the best course of action for you.
Frequently Asked Questions
Trigeminal neuralgia attacks are exquisitely sensitive to light tactile stimulation of specific facial trigger zones. The most common triggers include eating or chewing (especially hard or chewy foods), drinking (particularly cold beverages), toothbrushing, shaving, light touching or washing of the face, speaking or smiling, applying makeup, cold air or wind on the face, and sudden temperature changes. Each patient has individualised triggers and trigger zones, often located on the cheek, lip, or nasal area. Identifying these allows patients to modify activities that provoke attacks and improve quality of life.
Medical management is the first line of treatment. Carbamazepine is the most effective and best-evidenced medication, working by stabilising overactive sodium channels in the trigeminal nerve; it provides relief in approximately 70–80% of patients initially. Oxcarbazepine is a well-tolerated alternative with fewer side effects. Second-line agents include lamotrigine, baclofen, gabapentin, and pregabalin, often used in combination when monotherapy is insufficient. Medications require dose titration, and their efficacy often decreases over time as the condition progresses, which may eventually necessitate surgical consideration.
Not necessarily, but the natural history of TN tends toward progressive worsening with longer, more frequent episodes and diminishing medication efficacy over time. A proportion of patients achieve long-term remission and never require surgery. However, for those with refractory pain where medications cause intolerable side effects or lose effectiveness surgical intervention (microvascular decompression, percutaneous procedures, or stereotactic radiosurgery) offers durable relief that medications cannot. Surgery is not a ‘last resort’ for suitable patients, especially younger individuals, microvascular decompression provides the highest and most durable cure rate of any treatment for TN.
