Hi, I’m 17 and have bilateral trigeminal neuralgia in all three branches of the nerve. The shocks of pain are mainly triggered by heat and its disrupting my everyday life as I cant do any exercise that increase my body temp too much and at school its absolute torture. I was on Tegretol for a while but had to stop it because of the side effects, I’m now not on any medication simply because my doctor wont give me any and told me to take neurofen instead…. which shows just how little he knows. I would like to know what could be causing this??

I would also like to mention some of the many other symptoms I’ve been getting. I feel constantly tired and fatigued and have trouble staying awake during lessons, its even worse when the weather is warm. Sometimes when I get warm and the neuralgia triggers I would also get a shooting electric shock like pain in my back, not always in the same place, sometimes in the shoulders or jut traveling down my back. Now and then I have trouble with my vision, I just struggle to focus on things but I’m not sure if this is due to tiredness or not. I keep getting numbness in my toes that can be so intense at times it feels like my toe is being crushed and a week ago I went for around 5 days where I kept getting really intense throbbing/aching like pain in really random places every hour or so, mostly in my right arm. Can anyone shed any light on what could be causing these, so called odds and ends of symptoms?

Answered by: Maria/MD Health Forum.com Team

Trigeminal neuralgia is a pain condition that affects the trigeminal nerve (the 5th cranial nerve) which is responsible for transmitting sensations of touch, pain, pressure, and temperature from the face to the brain. Patients with trigeminal neuralgia suffer from episodes of intense facial pain.

The cause of trigeminal neuralgia is unclear. Some believe that it occurs when a blood vessel presses on the root of the trigeminal nerve as it exits the brainstem. The pressure on nerve, damages its protective coating called myelin sheath, causing it to malfunction. Trigeminal neuralgia symptoms may also be related to multiple sclerosis, a disorder that also damages the myelin sheath. Another possible cause is tumor that compresses the trigeminal nerve.
In some cases, however, the cause can’t be identified.

Symptoms of trigeminal neuralgia is confined into one or more distributions of the trigeminal nerve such as the eyes, forehead, and lower face. Excruciating pain may be triggered even by mild stimulation of the face such as chewing, smiling, touching the face, brushing the teeth, shaving, or feeling slight wind or breeze on the face. Sometimes pain spells occur or worsen without any facial stimulation.

The symptoms you mentioned –fatigue, numbness in the toes, bouts of shooting pain in the back, vision changes–call for an evaluation of a physician as they may indicate other health problems. Trigeminal neuralgia symptoms are also known to occur in people with multiple sclerosis, a disease in which the body’s immune system damages the nerves’ protective sheath. This disrupts the communication between your brain and the rest of the body. Later on, this can lead to the deterioration of the nerves themselves. Multiple sclerosis produces a wide range of symptoms depending on the severity of damage and which particular nerves are affected.

I would suggest that you also tell him about all the symptoms that you have been experiencing. Aside from your health history and the findings on neurologic examination, doctors may also request for magnetic resonance imaging to identify areas of the nervous system where myelin sheath damage has occurred. Lumbar puncture is also diagnostic procedure for multiple sclerosis. This test is helpful in determining the concentration of immune cells and proteins in cerebrospinal fluid, a clear liquid that delivers nutrients to the brain and spinal cord
Dr. Joshua has a blog entry about multiple sclerosis diagnostic criteria.

Aside from anticonvulsants, muscle relaxing agents may also be prescribed to patients with trigeminal neuralgia. If you think that the drug prescribed to may not be enough, you can always ask your doctor about how you could benefit from his drug of choice.

This blog entry is for general information only. I recommend that you discuss your symptoms with your own doctor.

Sources:
Schulder,M. 2003. Handbook of stereotactic and functional neurosurgery. Informa Healthcare.
http://www.hmc.psu.edu/healthinfo/t/trigeminalneuralgia.htm
http://www.merckmanuals.com/home/sec06/ch096/ch096e.html
http://www.mult-sclerosis.org/whatisms.html
http://www.mayoclinic.com/health/multiple-sclerosis/DS00188
http://www.mayoclinic.org/multiple-sclerosis/diagnosis.html

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Tags: facial pain, Fatigue, Multiple Sclerosis, numbness, Trigeminal Neuralgia

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