What Causes Trigeminal Neuralgia to Flare Up?

Valley Gamma Knife: What Causes Trigeminal Neuralgia to Flare Up?

Trigeminal neuralgia flare-ups are an unfortunate reality for many patients. As you learn more about your condition, you have likely wondered what causes trigeminal neuralgia to flare up. Some patients already know their triggers, but if you have only been recently diagnosed you may be unaware of some of the common things that can bring on bouts of pain.

The information below will help you better understand what causes trigeminal neuralgia to flare up, helping you avoid future attacks. However, it is also worthwhile to learn about trigeminal neuralgia treatment options in the NJ area that can address the root of the problem. Understanding more about your condition, specific triggers, and your available treatment options can help set your mind at ease throughout the entire process.

About Trigeminal Neuralgia

Trigeminal neuralgia is a chronic pain condition characterized by bouts of excruciating pain without an appropriate stimulus. That means that you feel intense pain in response to normal touch, or even without any perceptible contact. Some patients experience a constant dull pain in between bouts, though others will be pain-free during these periods. Many people will begin having painful attacks more and more frequently until they subside again into remission. Due to these extremely painful attacks, trigeminal neuralgia is known by many as the “suicide disease”.

Though trigeminal neuralgia used to be difficult to diagnose and treat, doctors now understand the pathology of the disease. In most cases, pain arises because some structure (most often a blood vessel) is pressing on the trigeminal nerve, the nerve that sends sensation and pain signals from the face to the brain. As a result, the nerve fires when it shouldn’t, causing terrible pain in response to “normal” touch.

Trigeminal Neuralgia Triggers

The difficulty of living with trigeminal neuralgia is that it tends to be regular, daily activities that are what causes trigeminal neuralgia to flare up. This is why many doctors will recommend treatment, as avoiding daily activities can be both difficult and disruptive. Though what triggers acute attacks will vary from patient to patient, common activities that cause trigeminal neuralgia to ramp up include:

  • Hot, cold, spicy, or sour foods and beverages
  • Brushing your teeth
  • Gentle touch, including a breeze or face washing
  • Shaving
  • Blowing your nose
  • Putting on makeup or facial lotion
  • Talking and making facial expressions, such as smiling

Treating Trigeminal Neuralgia

The good news is that there are treatment options available to patients in the tri-state area. If your doctor recommends treatment for your trigeminal neuralgia, the first step is typically a prescription medication to help limit your attacks. Common medications include antidepressants (Amitriptyline), anti-seizure medications (Tegretol) and muscle relaxers(Baclofen). Interestingly, opioids are not effective in treating trigeminal neuralgia pain and are not recommended as part of the treatment regimen.

Sometimes medication is not enough to prevent your trigeminal neuralgia attacks or its effectiveness declines over time. When this occurs, the next step is to undergo treatment to resolve the anatomical issue that is causing your condition. Two ways to accomplish this are microvascular decompression (MVD) surgery and Gamma Knife Radiosurgery.

Microvascular Decompression

MVD is a surgical procedure that takes place in a hospital while you are asleep, requiring a hospital stay of a few days. The surgeon will access the area where the vessel is pressing on the trigeminal nerve through a small incision and then place a piece of Teflon between the two to alleviate the friction. This procedure is typically recommended for younger patients who are good surgical candidates, without complicating health conditions. Following MVD, most patients will spend 3-4 days in the hospital, followed by about a week of activity restrictions recovering at home.

Gamma Knife Radiosurgery

In contrast to MVD, Gamma Knife Radiosurgery is an advanced form of radiation therapy that does not involve any scalpels or incisions and is performed in an outpatient setting. There is no hospital stay required, and most patients are able to return to activities (including work) within a day or two.

Gamma Knife Radiosurgery uses multiple beams of highly focused radiation to target the structure that is putting pressure on your trigeminal nerve. The precision of the system allows your clinical team to remove the impingement without damaging nearby structures, reducing the risk of nerve damage compared to surgery. Additionally, because it is a relatively minimally invasive treatment, recovery is shorter and milder, with less pain and healing time.

Keeping Your Pain at Bay

At this point, you likely have a better understanding of what causes trigeminal neuralgia to flare up, as well as the treatment options available to prevent attacks from occurring. Your doctor will make treatment recommendations based on your individual symptoms and health factors, and most patients will be put on a course of prescription medications before other treatment options.

If you do not have a procedure scheduled and are working to prevent painful attacks, it can be helpful to keep track of what you believe triggers your pain. If you notice an increase in pain following strenuous activities, illness, certain foods or any other remarkable event, take note of that and bring it up with your doctor. This can help you avoid any activities that can cause an increase in your pain, allowing you to be more comfortable and keeping your pain at bay for as long as possible.

Anthony D’Ambrosio, M.D., M.B.A., F.A.A.N.S
Anthony D’Ambrosio, M.D., M.B.A., F.A.A.N.S
Dr. Anthony D’Ambrosio is a board-certified neurosurgeon that specializes in Neurosurgery, Stereotactic Radiosurgery, Gamma Knife Radiosurgery (GKRS) and more. He is the Director of Neurosurgery and Co-Director of the Gamma Knife Program at The Valley Hospital. Dr. D’Ambrosio is an expert in treating patients with trigeminal neuralgia, benign or malignant brain tumors, as well as many other neurological conditions.

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