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