Trigeminal Neuralgia

[Sprit1947]

I have recently been diagnosed with trigeminal neuralgia but my symptoms are not really like I have seen on the internet.  I do not have sharp, cutting or electric like pains that last for a few seconds.  I have a very painful aching sensation that will last for 1 hour or longer.  I have been on carbamazepine 200 mg for 3 weeks and while the pain is a lot better I am still in almost constant aching pain.  Is this normal and will the carbamazepine eventually work?  I can stand it if I could know that what I have is also normal and will eventually get better.  I just wonder if it could be something else since I really do not fit the typical symptoms of Trigeminal Neuralgia

[sunshine20618]

I am 26 and have suffered from TN for 4 years.  I am ANYTHING BUT TYPICAL when it comes to "normal" TN.  I believe there is no NORMALCY to it!  I have had pain on both sides, and my pain lasts sometimes hours!  I sometimes have aching, sometimes have stabbing pain.  I would strongly recommend going to a neurologist.  And all the "typical" medications used to treat tn have not worked for me!  Don't give up until you find one that works for you.  Here are some examples I have tried that you  might want to give a shot: neurontin, tegretol, lamictal, dylantin, keppra, and what has worked best for me is a combination of trileptal and pamelor.  Good luck and if you have any questions I'd be happy to help give my support and experience with you:)

[Sprit1947]

PS. By the way, I am 61 years old.

[Sprit1947]

Thanks for the response.  I do have a follow up visit with my internist next week.  I have not been seen by a neurologist, so I guess that looks like the next step.

[JainMD]

Hi Sprit,
How old are you?
Trigeminal neuralgia is characterized by frequent, excruciating paroxysms of pain in lips, gums, cheek, or chin lasting seconds to minutes.
The Pain which is severe in nature, stabbing type, lasting for few seconds to minute and which has a triggering factor to it describes pain of trigeminal neuralgia.
Physical examination of the patient is normal. Most patients cause is compression due to overgrowth like some tumor in its pathway.
Typically presents in middle or old age. Pain is often stimulated at trigger points.
Sensory deficit cannot be demonstrated. This condition must be distinguished from other forms of facial pain arising from diseases of jaw, teeth, or sinuses.
Rare causes are herpes zoster or a tumor.
Comprehensive pain management care is helpful.
Carbamazepine is effective in 50–75% of cases.
Carbamazepine is drug of choice, but along with Baclofen it serves good result for episodic pain. There are other newer anti-convulsants like toprimate which could be tried, but it depends on neurologist comfort with the drug.
For non-responders, phenytoin or baclofen can be tried. When medications fail, surgical lesions (heat or glycerol injection) can be effective.
Keep me informed if you have any queries.
Bye.