Trigeminal Neuralgia

WHAT YOU SHOULD KNOW:

• Trigeminal neuralgia (TN), or tic douloureux, is when a problem with your trigeminal nerve causes severe (very bad) facial pain. You have a trigeminal nerve on each side of your face, and each nerve has three branches. Each nerve branch allows you to feel sensations, such as pain, touch, and temperature changes in different areas of your face. The trigeminal nerve also helps with eating functions, such as biting, chewing, and swallowing. The facial pain with TN can occur in one, two, or all three of the nerve branch areas. TN pain normally only occurs on one side of your face but can occur on both sides. TN causes sudden, sharp, burning, or shock-like pain attacks in the area linked to the problem nerve branch. TN attacks are normally brought on by triggers including eating, talking, shaving, brushing your teeth, wind, and noise.
  
  
• Most attacks occur during the day and may last from less than one second up to two minutes. You may have repeat attacks for minutes to hours. The repeat attacks may occur from weeks to months to years, and often get worse over time. TN pain attacks may occur more often and be more painful as you age. TN may be caused by a blood vessel or tumor (growth) pressing on your trigeminal nerve. This pressure may damage the nerve and cause it to send wrong impulses (messages) to your brain, leading to facial pain. TN may also be caused by multiple sclerosis, an injury, or a stroke. Your risk for TN increases if you are older than 50, female, or have a close family member with TN.
  
  
• You will need a physical exam and imaging tests, such as an MRI, to diagnose your TN. TN may go away on its own, or you may need treatment to decrease or resolve your pain. Treatments include medicines, or procedures and surgeries to block or destroy the problem nerve area. Your caregiver may also suggest alternative treatment options, such as meditation and acupuncture. Treating your TN may help decrease your pain and the number of attacks you have. Treatment may help you return to your normal daily activities.

AFTER YOU LEAVE:

Medicines:

• Keep a written list of the medicines you take, the amounts, and when and why you take them. Bring the list of your medicines or the pill bottles when you see your caregivers. Learn why you take each medicine. Always keep your TN medicines within reach at home or when traveling. Even if you have not had TN symptoms for a long time, keep your medicine nearby. If your symptoms return, contact your caregiver before starting to take your medicines again. Do not use any other medicines, over-the-counter drugs, vitamins, herbs, or food supplements without first talking to caregivers.
  
  
• Always take your medicine as directed by caregivers. Call your caregiver if you think your medicines are not helping or if you feel you are having side effects. Do not stop taking your medicines without talking with your caregiver first. Stopping your TN medicines suddenly can cause a bad reaction and your symptoms may return. If you are taking medicine that makes you drowsy, do not drive or use heavy equipment.
  
  
• Anticonvulsants: Anticonvulsants are medicines given to control seizures. These medicines may be used to help prevent TN pain attacks and decrease your TN symptoms.
  
  
• Antidepressants: Antidepressant medicines may be given to help decrease your pain and help prevent depression (deep sadness).
  
  
• Muscle relaxers: Muscle relaxers are medicines to help relax your muscles. When your facial muscles are relaxed, you may be less likely to have pain attacks.
  
  
• Pain medicines: You may be given pain medicines to help decrease your facial pain.

Follow-up visits:

Ask your caregiver when to return for follow-up visits. You may need to have blood tests to check your blood levels of certain medicines. Ask your caregiver how often you need to return to have these blood tests. Keep all appointments. Write down any questions you may have. This way you will remember to ask these questions during your next visit.

Alternative and other treatment options:

Your caregiver may suggest some alternative or other treatments to help decrease your TN pain. Ask your caregiver for more information about the following:

• Acupuncture: During acupuncture treatment, caregivers insert very thin needles just under your skin. This treatment may decrease your TN pain and improve healing. Always see a caregiver for acupuncture. Do not try to give this treatment to yourself.
  
  
• Biofeedback training: Biofeedback is a special way to control how your body reacts to things like stress or pain. The first step in this training is to use electrodes (wires) to monitor your body responses. These electrodes are placed on different parts of your body, such as your chest. The electrodes are attached to a TV-type monitor which gives a paper tracing of your heart beating. You will learn how to control body changes, such as slowing your heart rate, when you become upset.
  
  
• Chiropractic care: Chiropractic care may include manipulation, which is when caregivers move your joints, such as your jaw or neck. Caregivers may also massage painful areas. Ask your caregiver for information about Chiropractic care and if it is right for you.
  
  
• Cognitive behavior therapy: Cognitive behavior therapy (CBT) helps you to change your behavior. It may help you better handle your TN symptoms. CBT also trains you how to cope with your TN.
  
  
• Meditation and relaxation therapy: Meditation teaches you how to focus inside yourself. The goal of meditation is to help you feel more calm and peaceful. Relaxation therapy teaches you how to calm your body and mind. The goal is to feel less physical (body) stress and have less emotional (mind) stress. You may also be taught self-hypnosis to help you learn how to relax by deep concentration (focused attention).

For support and more information:

Having TN can be hard for you and your family. You and your family may feel scared and worried about your pain. It is common to feel depressed when you have TN. Talk with your caregiver about your feelings. You may want to join a support group with other people who have TN. You can also contact the following:

• American Chronic Pain Association
  PO Box 850
  Rocklin , CA 95677
  Phone: 1- 800 - 533-3231
  Web Address: http://www.theacpa.org
  

• Trigeminal Neuralgia Association
  2801 SW Archer Road
  Gainesville , FL 32608
  Phone: 1- 800 - 923-3608
  Web Address: www.tna-support.org
  

CONTACT A CAREGIVER IF:

• The medicines you are taking are not decreasing your TN pain.
  
  
• You feel worried and depressed and find it hard to do your daily activities, such as going to work.
  
  
• You have headaches, mouth sores, an upset stomach, or diarrhea that does not get better or go away.
  
  
• Your TN pain feels worse, different, or moves to another area of your face.
  
  
• You have questions about your condition or treatment.

SEEK CARE IMMEDIATELY IF:

• You have a fever, stiff neck, or you develop a skin rash or peeling skin.
  
  
• You have clear or yellow fluid leaking from your procedure or surgery site.
  
  
• You are feeling so depressed you want to harm yourself.
  
  
• You are confused and cannot think clearly.
  
  
• You are not eating or drinking, and you are losing weight.
  
  
• You have eye pain, eye numbness, or sudden vision or hearing changes.
  
  
• You have sudden dizziness, problems with movement, weakness, or numbness in your face.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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