day; upwards of 70 attacks in one day have been reported. Common triggers to the acute pain include brushing one’ s teeth, applying make-up, or shaving. In some instances, a quick diagnosis can be made as makeup will noticeably be absent from a particular area of the face.
The pain is typically located around the cheek bone or lower face and involves the forehead in less than 5 % of cases. This location is important in differentiating TN from other types of headache or facial neuralgias.
potential drug interactions. Oxcarbazepine is a derivative of carbamazepine which has a better side effect profile and may be more effective in those patients in whom carbamazepine was ineffective. Topiramate, in randomized controlled trials in China, was found to be more effective than carbamazepine after 2 months of treatment. Lamotrigine has been effective in classic and symptomatic TN, which occurs secondary to multiple sclerosis. However, the potential of Stevens-Johnson syndrome, a serious skin condition, may limit its use. Gabapentin and pregabalin have shown success with less side effects than the previously mentioned agents. Baclofen is another drug that has been shown to be effective when used alone or in combination with other agents.
Ophthalmic n. zone
Maxillary n. zone
Common trigger points
Mandibular n. zone
The overall course of TN has a relapsing-remitting nature with at least 50 % of patients reporting at least a 6-month remission – free from pain. The pain of TN can occur at night in one-third of patients. Unfortunately, TN almost always returns and becomes unresponsive to treatment. The pain can be quite disabling and impacts on all aspects of the patient’ s life.
The diagnosis of TN is usually based on the patient’ s symptoms. However, an MRI of the brain, with and without contrast, is the most useful screening study to rule out secondary causes such as multiple sclerosis or brain tumors which may present with symptoms typical of TN.
Symptomatic treatment of TN dates back to 1958 with the introduction of an anti-seizure drug, phenytoin. Since that time, various other seizure agents have been tried with varying degrees of success. The most effective and first-line agent in TN therapy is carbamazepine. Unfortunately, the use of carbamazepine is limited by its adverse reactions including drowsiness, potential blood side effects, and
When medical therapies fail or the disease is causing a significant impact on quality of life, the physician may suggest neurosurgical procedures which have been effective. Microvascular decompression of a nerve which involves relieving the compression caused by a blood vessel on a nerve, has been used successfully. Other procedures can be used to prevent pain signal transmission through nerves. These include using heat( using radiofrequency ablation, chemical( rhizolysis), mechanical( using balloon compression), and radiation( gamma knife). Some data suggest that many patients prefer a surgical option rather than ongoing medical management. The following list provides definitions of these procedures:
1. Radiofrequency lesioning / ablation( same technique): Radio frequency waves are used to heat needles. When these needles come in contact with a particular nerve, the nerve is destroyed or“ lesioned” and can no longer transmit pain signals
14 HeadWise ® | Volume 6, Issue 1 • 2016