The First-line Medication for Primary Trigeminal Neuralgia

For primary trigeminal neuralgia, the first-line treatment typically involves the use of anticonvulsant medications. Commonly prescribed drugs include carbamazepine, phenytoin, gabapentin, and pregabalin. These medications help to stabilize the nerve signals and reduce the painful episodes associated with this condition.

When Medication Isn't Enough

If pharmacological treatment fails to provide adequate relief, a surgical procedure known as microvascular decompression may be considered. This procedure involves identifying the blood vessel responsible for compressing the nerve and placing a small Teflon pad between the vessel and the nerve to alleviate pressure. This can significantly reduce or even eliminate the pain associated with trigeminal neuralgia.

Understanding the Cause of Primary Trigeminal Neuralgia

Primary trigeminal neuralgia is generally believed to result from neurovascular compression. As people age, particularly after the age of 40 to 50, arteries may begin to show signs of atherosclerosis and lose some of their elasticity. When this occurs near the trigeminal nerve, the pulsating arteries can irritate the nerve, especially at its root where it lacks a protective myelin sheath. This irritation can lead to abnormal nerve signaling and intense pain episodes.

Symptoms and Triggers

The pain experienced by patients is often described as sharp, stabbing, burning, or electric shock-like. It tends to start and stop suddenly. Everyday activities such as washing the face, brushing teeth, rinsing the mouth, or chewing food can trigger these painful episodes. These specific movements are commonly referred to as trigger points, and patients often learn to avoid them to reduce the likelihood of an attack.