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Suggest Treatment For Trigeminal Neuralgia

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Posted on Tue, 18 Oct 2016
Question: My doctor told me I have trigeminal neuralgia. I had an MRI completed and the impression stated "No causeative trigeminal neuraligia identified. He still tells me I have it. I have facial and head pain but no sharp pain. Your opinion, please.
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Answered by Dr. Olsi Taka (58 minutes later)
Brief Answer:
Read below

Detailed Answer:
I read your question carefully and I understand your concern.

Regarding the MRI report I am afraid that it doesn't change much in the diagnosis. MRI (or any test) does not see trigeminal neuralgia, it is a diagnosis made based on the symptoms. What the MRI is done for is because there is a small percentage of trigeminal neuralgias which are due to something compressing the nerve such as an abnormal blood vessel or a tumor. So it is necessary to exclude such causes which might need surgery, but in most cases nothing is found.

As for whether to continue Cabamazepine...it is true that trigeminal neuralgia usually is in the form of sharp lancinating pain, but there are variations. Also at times in everyday practice there are facial pains which are difficult to classify, do not fulfill the criteria for the most well known categories. That doesn't change though that they may respond to the same treatment. Cabamazepine is used to alleviate the pain, not to cure the cause and it is effective in many other headaches apart from trigeminal neuralgia, many antiepileptics are used for pain control and prevention. Since with MRI we have excluded threatening causes (I am assuming dental causes are not suspected either) have been excluded, I do not see anything wrong in alleviating the symptoms.
So since you say it to be effective and it is a small dose which shouldn't cause much side effects, if the pain bothers you I do not see much wrong in continuing it for some time whether it is a trigeminal neuralgia form or another unclassified facial pain.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka (16 hours later)
Following left shoulder surgery, I've been going to physical therapy. My PT says the muscles in my neck and shoulders are very tight. My facial pain is mainly on my right side, including my ear area. I do have TMJ. My question is do you think massage, chiropractic, and or PT will help the TN? If I can get the muscles loosened, do you think the TN will go away?
Thanks for your help.
Opal Coughlin
doctor
Answered by Dr. Olsi Taka (14 hours later)
Brief Answer:
PT won't help TN

Detailed Answer:
If it is true trigeminal neuralgia then no, there is not much that the physical therapy or massage will do for it, it plays no role on the trigeminal nerve.

If the pain though starts in the neck and seems to spread secondarily in the head and face, then since symptoms are not typical for TN one might suspect that it is a case of the neck issue irradiating in the head and face where the physical therapy might help. If no neck pain and only in the face though it is unlikely.

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3674 Questions

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Suggest Treatment For Trigeminal Neuralgia

Brief Answer: Read below Detailed Answer: I read your question carefully and I understand your concern. Regarding the MRI report I am afraid that it doesn't change much in the diagnosis. MRI (or any test) does not see trigeminal neuralgia, it is a diagnosis made based on the symptoms. What the MRI is done for is because there is a small percentage of trigeminal neuralgias which are due to something compressing the nerve such as an abnormal blood vessel or a tumor. So it is necessary to exclude such causes which might need surgery, but in most cases nothing is found. As for whether to continue Cabamazepine...it is true that trigeminal neuralgia usually is in the form of sharp lancinating pain, but there are variations. Also at times in everyday practice there are facial pains which are difficult to classify, do not fulfill the criteria for the most well known categories. That doesn't change though that they may respond to the same treatment. Cabamazepine is used to alleviate the pain, not to cure the cause and it is effective in many other headaches apart from trigeminal neuralgia, many antiepileptics are used for pain control and prevention. Since with MRI we have excluded threatening causes (I am assuming dental causes are not suspected either) have been excluded, I do not see anything wrong in alleviating the symptoms. So since you say it to be effective and it is a small dose which shouldn't cause much side effects, if the pain bothers you I do not see much wrong in continuing it for some time whether it is a trigeminal neuralgia form or another unclassified facial pain. I remain at your disposal for other questions.