Trigeminal neuralgia 3 of 4

Screening and diagnosis

If you go to your dentist, an examination of your mouth can reveal whether a problem with your teeth or gums is causing your pain.

If you go to your doctor, he or she will want to ask about your medical history and have you describe your pain — how severe it is, what part of your face it affects, how long pain lasts and what seems to trigger episodes of pain. You'll also undergo a neurologic examination. During this examination, your doctor examines and touches parts of your face to try to determine exactly where the pain is occurring and — if it appears that you have trigeminal neuralgia — which branches of the trigeminal nerve may be affected.

Your doctor may exclude other possible conditions based on your medical history, the examination, and a magnetic resonance imaging (MRI) scan of your head.

Treatment

Medications are the usual initial treatment for trigeminal neuralgia. Medications are often effective in lessening or blocking the pain signals sent to your brain. A number of drugs are available. If you stop responding to a particular medication or experience too many side effects, switching to another medication may work for you.

Medications

·       Carbamazepine (Tegretol, Carbatrol). Carbamazepine, an anticonvulsant drug, is the most common medication that doctors use to treat trigeminal neuralgia. In the early stages of the disease, carbamazepine controls pain for most people. However, the effectiveness of carbamazepine decreases over time. Side effects include dizziness, confusion, sleepiness and nausea.

·       Baclofen. Baclofen is a muscle relaxant. Its effectiveness may increase when it's used in combination with carbamazepine or phenytoin. Side effects include confusion, nausea and drowsiness.

·       Phenytoin (Dilantin, Phenytek). Phenytoin, another anticonvulsant medication, was the first medication used to treat trigeminal neuralgia. Side effects include gum enlargement, dizziness and drowsiness.

·       Oxcarbazepine (Trileptal). Oxcarbazepine is another anticonvulsant medication and is similar to carbamazepine. Side effects include dizziness and double vision.

Doctors may sometimes prescribe other medications, such as lamotrignine (Lamictal) or gabapentin (Neurontin).

Some people with trigeminal neuralgia eventually stop responding to medications, or they experience unpleasant side effects. For those people, surgery, or a combination of surgery and medications, may be an option.