Online Health Chat with Badih Adada, MD

March 28, 2017


Description

Trigeminal neuralgia is a chronic condition affecting the trigeminal cranial nerve, which provides sensation to the face and helps control jaw movement. The trigeminal nerve is one of the most widely distributed nerves in the head and carries feeling from your face to your brain.

Trigeminal neuralgia is commonly the result of compression of the trigeminal nerve by a blood vessel in the brain. It can also be caused by other neurological conditions such as brain tumors, multiple sclerosis, aneurysms, as well as other neurological disorders.  It is more likely to occur in adults over the age of 50, and affects women more frequently than men.      

Often people suffering from this chronic disorder will describe experiencing a headache; however, it is actually resulting from facial pain.  There are several different types of facial pain syndromes, with the most common one being trigeminal neuralgia.

Patients suffering from trigeminal neuralgia may experience sudden burning or shock-like stabbing sensations in their face.  These sporadic episodes can last anywhere from seconds to a few minutes and can be triggered by everyday activities including chewing, eating, teeth brushing, talking and even smiling. 

Initially, these attacks can be short and mild but can progressively worsen over time, increasing in both frequency and duration.  This disorder can be debilitating to patients, decreasing their quality of life.  However, there are currently a variety of treatment options that can help manage symptoms and reduce pain. 

The Trigeminal Neuralgia program at Cleveland Clinic Florida brings together a collaborative team of specialists and subspecialists to evaluate and manage patient suffering from trigeminal neuralgia.  This multidisciplinary team approach to care offers:

  • Advanced diagnostics, including ultra-high resolution MRI when necessary
  • Medication therapy
  • Non-surgical treatments such as botulinum injections and trigeminal nerve blocks
  • Microvascular decompression
  • Percutaneous procedures
  • Noninvasive stereotactic radiosurgery - an outpatient procedure completed in one day

Our specialists also manage unusual and complex cases including patients with bilateral involvement and multiple sclerosis and older patients ineligible for other treatments.  Our staff has special expertise in revising previous trigeminal neuralgia surgeries and providing options when previously successful interventions no longer control pain. 


About the Speaker

Badih Adada, MD is a Neurosurgeon, Chair of the Department of Neurosurgery and Director of the Braathen Neuroscience Center at Cleveland Clinic Florida.  He received his medical degree from the University of Montreal in Montreal, Canada. Dr. Adada went on to complete a general surgery and neurosurgery residency at the University of Montreal, Notre Dame Hospital, and a skull base surgery fellowship at the University of Arkansas for Medical Sciences in Little Rock. Dr. Adada is certified by the American Board of Neurological Surgery and the Royal College of Physicians and Surgeons of Canada. He is a member of the American Association of Neurological Surgeons and the American Medical Association. Dr. Adada’s specialties include skull base and vascular neurosurgery, movement disorders, and epilepsy surgery.


Let’s Chat About Trigeminal Neuralgia: Treatment Options for Facial Pain

Welcome to our Online Health Chat “Trigeminal Neuralgia: Treatment Options for Facial Pain" with Badih Adada, MD.  We are thrilled to have him here today for this chat. Let’s begin with the questions.

Symptoms and diagnosis

SandyD: I'm a 55-year-old woman with one-sided facial pain since 2011. I've been to many different specialists but my condition is still undiagnosed. There were no previous procedures or problems with my face except for a BCC removed from this area in 2009. Symptoms vary, but include: pain and tenderness centered on right side of face near nose, often also affecting outlying areas such as bridge of nose, gums on right side, ear, and sometimes aching and tenderness in right side of neck (along carotid artery). Feeling of pain is constant (not sudden, stabbing, or piercing); it is tingly and/or burning and/or deep aching; sometimes with pressure, sometimes not. Pain usually goes all the way down overnight but increases again as day progresses, especially from lots of mouth movement (from a lot of talking and/or smiling) and from physical movement that involves bending over. (Carbamazepine, Oxcarbazepine, and gabapentin don't help.) Any suggestions for causes and any test suggestions?

Badih_Adada,_MD: First your physician needs to make sure that there is no recurrence of the BCC. If there isn't, your pain is most likely a neuropathic pain. If medication was not of any benefit, then other modalities including biofeedback and injections can be considered.

Shopgirl60: How is trigeminal neuralgia diagnosed? Is MRI the only test used to confirm diagnosis? What other methods are used?

Badih_Adada,_MD:  Trigeminal neuralgia is typically diagnosed based on the history given by the patient. The MRI of the brain can be helpful in ruling out some pathologies that can be associated with trigeminal neuralgia such as some skull-based tumors or multiple sclerosis. The MRI can also be helpful in showing a vessel that is impinging on the trigeminal nerve and might be the cause of the pain.

Kristen1970: I started experiencing sharp pain when brushing my teeth and went to the dentist but they found nothing wrong. I’m still experiencing this pain from time to time. Could this be trigeminal neuralgia?

Badih_Adada,_MD: It is unlikely to be trigeminal neuralgia. Patients with trigeminal neuralgia will have spontaneous pain that can be also triggered by brushing teeth.

MickyM: I recently had a root canal and following the procedure have started to experience stabbing pain on that side of my face. Can dental procedures cause trigeminal neuralgia?

Badih_Adada,_MD: Patients can experience chronic facial pain after dental procedures. This can be what is known as trigeminal neuropathy but not necessarily trigeminal neuralgia. The treatment is usually medical and does not respond to surgical intervention


Vision Problems

Marie1: Can it cause double vision on the side where I have trigeminal?

Badih_Adada,_MD: If patients have double vision associated with trigeminal neuralgia then other causes of the symptoms need to be ruled out. Those might be tumors at the base of the skull or multiple sclerosis

sam2: Please explain difference between neuropathy and neuralgia. Thank you.

Badih_Adada,_MD: Patients with trigeminal neuropathy typically have damage to the trigeminal nerve that is causing the pain. Patients with trigeminal neuralgia have irritation of the nerve that can be reversible

Marie1: If MRI has ruled out many things. Can the double vision (vertical) be from the trigeminal neuralgia?

Badih_Adada,_MD: It is very unlikely.

Moviebuff15: Can trigeminal neuralgia cause eye pain as well as tooth pain?

Badih_Adada,_MD: The trigeminal nerve has 3 branches, the first branch innervates the forehead and eye area at the second branch innervates the maxillary area ( around the cheek bone) and the third branch innervates the mandible or jaw area, depending on the branch that is involved patient's skin experience eye pain, tooth pain or both.


Types Of Pain

Mark575: How is Trigeminal Neuralgia different from other types of facial pain?

Badih_Adada,_MD: The description of the pain in trigeminal neuralgia is different from other types of facial pain, typically patients with trigeminal neuralgia will have sudden onset electric, shock-like sensation in the face that is triggered either by touching the face or eating.

dhysell123: Can the pain for TN be constant and not just all of a sudden and brief?

Badih_Adada,_MD: Yes it can however this is not what we typically see in patients with trigeminal neuralgia.


Symptoms Triggers and Diet

Blueyes01: Does eating certain foods trigger TN symptoms? Are there foods I should avoid? Any special diet I should follow?

Badih_Adada,_MD: Cold foods are described to trigger trigeminal neuralgia symptoms. The type of food however does not seem to have specific correlation with triggering symptoms.

RunnerJD: Can trigeminal neuralgia symptoms be triggered by stress?

Badih_Adada,_MD: Yes


Medication Therapy Advances

sam2: I’m a 68 year old male diagnosed with TN in January 2017 & have a history of facial pain for 3-4 years, but much worse recently in past 3-4 months. CT of head normal on 3/06/17. One treatment of acupuncture without relief on 2/24/17. Taking daily meds of Cozaar, Zocor, Asa 81mg, Hytrin, Multivit, Mobic. What are the newer drugs recommended other than Tegretol? Does acupuncture usually take more than one treatment? Thank you in advance for your answer.

Badih_Adada,_MD: The initial drug of choice for trigeminal neuralgia is Trileptal. Typically, if the first acupuncture treatment did not help it is unlikely that further treatments will be of benefit.

sam2: I am a 69 yr old white male recently diagnosed with TN but has had pain on left side of face many years and worse recently these past two months. Taking Oxcarbazepine 300mg twice a day for 2 weeks. Failed relief from acupuncture. Has continued to experience pain, but not a constant discomfort. Any better meds?

Badih_Adada,_MD: Typically, there are 3 classes of medication that can be of benefit for patients with trigeminal neuralgia. The first class on anticonvulsant medication which Oxcarbazepine is part of, other medications within that class include Gabapentin and Topiramate. The second class of medication consists of antispasmodics such as Baclofen. Finally, some studies have shown that Botox injections can be of benefit for patients with trigeminal neuralgia.

sam2: So neuropathy is treated with medicine usually?

Badih_Adada,_MD: Yes

WaveWolf: I have neurosarcoidosis and relatively infrequent "attacks" of TGN pain that are severe and debilitating. Should I try a medicine that purports to prevent attacks, such as Trileptal?

Badih_Adada,_MD: If the attacks are debilitating and severe then you should consider being on medication to prevent them. Trileptal would be a good choice.


Medication Side Effects

OceanBlue05: I was placed on medication for my TN but have trouble concentrating? Is this a side effect of the medication?

Badih_Adada,_MD:  Concentration issues can be related to medication treating trigeminal neuralgia. Adjusting the dose can help reducing the side effect. If this does not help then switching to another medication is an option. On patients do not tolerate medication at all and are candidates for surgical treatment.


Surgical Options and Outcomes

Doglover305: What makes someone with TN a candidate for surgery?

Badih_Adada,_MD: Patients that do not respond to medication or have stopped responding to medication are candidates for surgery. Patients that have significant side effects from medication should also be considered for surgical treatment of trigeminal neuralgia

Seabreeze101: What can I expect in terms of recovery following surgery for TN? Also, will it only reduce my pain and not make it go away completely?

Badih_Adada,_MD: Typically patients would be in the hospital around 2-3 days. Patients are ready to resume their normal activities within 2-3 weeks after the surgery. The surgery (microvascular decompression for trigeminal neuralgia) is supposed to completely eliminate the pain.

Dreamer700: Are there risks or side effects related to MVD for the treatment of trigeminal neuralgia? If so, what are some of those?

Badih_Adada,_MD: Microvascular decompression (MVD) is a surgical procedure and any surgery has associated risks. The risks associated with Microvascular decompression are minimal. They include leakage of cerebrospinal fluid, facial numbness or weakness, hearing loss or dizziness. The risk of those issues occurring is very small.

TwinsNana: I underwent surgery a couple of years ago for my trigeminal neuralgia but am still experiencing pain. Should I consider another procedure if the first surgery did not alleviate symptoms?

Badih_Adada,_MD: The first step would be to understand why the surgery failed to alleviate the trigeminal neuralgia symptoms. If the nerve seems to be still compressed by a vessel then a redo surgery might be indicated. If there is no residual compression of the nerve then the cause of the pain needs to be determined. Some patients will benefit from radiosurgery or percutaneous procedures to alleviate the pain.

BettyBoo60: I'm currently considering surgery to relieve my TN symptoms. Following the procedure, how long does it take before I can go back to my normal activities?

Badih_Adada,_MD: Most patients can resume normal activities around 2 weeks after surgery.


Nerve Blocks for Pain

Finsfan33065: My wife suffers from TN and her physician recommended she have a trigeminal nerve block. Will that help in alleviating her symptoms? How long does it last?

Badih_Adada,_MD: Trigeminal nerve block can give temporary relief of trigeminal nerve pain. Depending on the medication that is used, the relief can last for a few weeks.


Radiosurgery for Trigeminal Neuralgia

Ladybug786: How does radiosurgery differ from other surgical options for trigeminal neuralgia? Is it less invasive?

Badih_Adada,_MD:  Radiosurgery consists of applying edema from radiation to the trigeminal nerve. This is done in the radiosurgery unit and does not require any incision. Patients would go home the same day after the procedure. Radiosurgery does not treat to cause of trigeminal neuralgia however it is successful in reducing the pain related to trigeminal neuralgia by stopping the transmission of painful impulses. Typically the benefit from radiosurgery is not as long-lasting as the pain relief obtained after surgical treatment.

TLC444: I am diagnosed with MS and also suffer from trigeminal neuralgia. What treatment options other than medications are available for me? I'm still experiencing a lot of pain.

Badih_Adada,_MD: Radiosurgery can be an option for patients suffering from trigeminal neuralgia in the context of multiple sclerosis. The procedure, percutaneous procedures such as glycerol injections or balloon compressions can also be indicated.


Non-Surgical Treatment Options

Jflores123: How effective are Botox shots in managing symptoms of TN? How often does the patient receive them?

Badih_Adada,_MD: Botox shots are typically not very effective in alleviating pain associated with trigeminal neuralgia. If they provide some relief they can be repeated every 3-6 months.

ViviD: Do non-surgical treatment options for TN offer permanent relief of symptoms? What about surgical treatments? Are those more effective than non-surgical?

Badih_Adada,_MD:  Some nonsurgical options to treat trigeminal neuralgia can provide long-term relief. A lot of patients on medication will be symptom-free for several years however a significant amount of those patients will progress to have recurrence of their symptoms. Typically, patients who undergo surgery and are relieved from their pain postoperatively will have permanent relief.

LindaR5615: Is acupuncture an effective treatment for TN? I’ve heard it works for some patients.

Badih_Adada,_MD: It is not effective for all patients. However we have seen patients get significant benefit and relief after acupuncture.


For Appointments

To make an appointment with Badih Adada, MD, Neurosurgeon or any of the other specialists in the Neurological Center at Cleveland Clinic Florida, please call 877.463.2010.  You can also visit us online at www.clevelandclinicflorida.org.


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