Trigeminal neuralgia (TN) is a state of chronic pain caused by a sickness of the fifth cranial nerve, the nervus trigeminus. TN frequently starts abruptly as sudden immense lighting-like pain which is persistent for few seconds up to a couple of minutes.
It may appear once a day or it can happen in series. People with this disorder often hesitate to cut their beard and hair, even to palpate their head because they think that they can start the painful episode in that way. Although TN is not common, it is the most often the cause of facial pain and of the most painful disorders.
The trigeminal nerve has tree branches: ophtalmic, maxillary and mandibular nerve. One can have TN in one or several branches, the pain is more often in lower parts of the nerve. This nerve is responsible for sensation of the face, mouth and facial part of the scalp, and it also has motor functions such as chewing. There are two trigeminal nerves, one from each side of the head. Three branches of trigeminal nerves combine themselves in the basal region of the skull in the region called the trigeminal or Gasserian ganglion.
The first step in TN therapy is the usage of medications that are taken orally. The next moves that are taken when medications do not help are injections or even surgery. Usually doctors combine a couple of methods for the best possible results.
Carbamazepine is the most used medicine for the state of trigeminal neuralgia. It is classified as an anti-convulsant or anti-epileptic drug (AED). The primary use of carbamazepine is to treat convulsions, but the irregular electric pain impulses in TN are comparable to those of seizures.
A positive reaction and alleviation of pain in patients is a good sign for TN diagnosis. This medication is mostly used for typical cases of TN. Therapy starts with a low dose of carbamazepin (around 100 mg) and the dose is slowly elevated with the passing of time until one reaches the dose of 1,200 mg per day, which is considered to be the upper limit. If one starts the treatment with higher doses, side effects (such as upset stomach and mental confusion) can occur, which eventually will cause the stop of using the carbamazepin.
Some other medications that are used for therapy are Gabapentin (Neurontin), Lamotrigine (Lamictal), Levateracitam (Keppra) and Oxcarbazepine(Trileptal).
There are even some medications that are originally used for other disorders, but they can find a place in TN therapy, for example doctors can prescribe benzodiazepines, opioids or anti-depressants due to similar effects.
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