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Trigeminal Neuralgia: Basic Clinical Concepts

Trigeminal neuralgia, often dubbed as tic duolorex, is a rare cause of facial pain. The overall prevalence of this medical condition is around 0.07%. This pain is often described as short-term, sharp and intense, and episodic in character.

It is mostly felt unilaterally and typically occurs in the regions of face innervated by the fifth cranial nerve (or trigeminal nerve); lower half of face and jaws. The pain is said to be severely excruciating and is always paroxysmal in nature.

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Distribution of the maxillary and mandibular nerves, and the submaxillary ganglion.

The overall frequency of painful occurrences is highly variable, ranging from 0 to 50 episodes per day, with painful symptoms often set off by minor stimuli such as jaw movements during eating/drinking, shaving, or even by touching one’s own face. Sometimes, the pain is severe enough for the patients to correlate this to receiving an electric shock.

Chillis as relief from trigeminal neuralgia pain?

In 2019, following surgery on my jaw, I developed temporary trigeminal neuralgia.  For nearly 3 days post-surgery, I was surprisingly pain-free.  On the third day, the pain struck like a lightning bolt. It was mind-blowingly bad. 

Now, as a former neuro nurse, I was familiar with TGN patients and their pain levels, but I guess I could never have really understood how bad it was.

Fortunately, I had been soaking some super-hot chillis in olive oil for some months, and I knew from the research to apply the oil to the affected area of my face.  The relief came within a minute and lasted for some hours.

So this chilli oil in combination with CBD oil (consumed orally) made an effective treatment for the pain for the following month or so that I suffered the trigeminal neuralgia episodes.

Whilst chillis are well known to relieve the pain, they fail to treat the underlying causation.

Chilli for therapy of trigeminus neuralgia.
A case report:

The symptoms of trigeminal neuralgia tend to occur repetitively over a period of weeks or even months and this may be followed by pain-free intervals. A majority of cases occur secondary to mechanical compression of the trigeminal nerve, particularly at the point where it arises from the brainstem. This is mostly due to localized vascular abnormality. Still, however, some patients of trigeminal neuralgia might be diagnosed with an underlying demyelinating disorder such as multiple sclerosis. A few patients might also present with a deeply rooted malignancy, including brain tumours such as meningiomas.

To diagnose such complicated cases, it is essential to perform a brain imaging study such as an MRI (magnetic resonance imaging) or CT (computed tomography) scan. Otherwise, most medical experts emphasize that the diagnosis of trigeminal neuralgia should be largely based on the patient’s clinical presentation.

The management of trigeminal neuralgia is initially carried out through a conservative approach. Anti-epileptic medications are the crux of pharmacotherapy where carbamazepine/oxcarbazepine is the most preferred treatment option.

For some patients, an additional drug (e.g., gabapentin) might be used if facial pain is not fully relieved. Perhaps the most effective treatment strategy for trigeminal neuralgia is the surgical intervention which may be carried out via the following approaches:

  1. Open surgical decompression; performed by removal of the vascular anomaly.
  2. Destruction of the nerve root via a percutaneous approach (glycerol rhizotomy)
  3. Radiological lesioning of the nerve root (stereotactic radiofrequency rhizotomy). Gamma knife and Cyberknife are two modern interventions utilized for this procedure.

It has been observed that surgical intervention is followed by long-term medical therapy in a majority of cases.

It is noteworthy that finding a sound aetiology for trigeminal neuralgia is a major step in its clinical management. If necessary, imaging scans should be performed and targeted therapy must be initiated for providing immediate pain relief in this agonizing condition.

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