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Neuralgia
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Neuralgia

I read the response posted to a question regarding trigeminal neuralgia and its relationship to head trauma. The response was that any such relationship was "very rare."
However, as a neurologist with over 15 years experience, I have seen many cases of trigeminal neuralgia following head trauma. We usually refer to these cases as "Atypical trigeminal neuralgia" to distinguish them from those "idiopathic" cases which are mostly attributable to microvascular compression.
Through similar pain mechanisms as those involved in post-traumatic pain in a limb, post-traumatic neuralgia in the trigeminal distribution can result from trauma to any branch of any of the three divisions intra or extra-cranially.
Although the central mechanisms of the perceived pain also involve the trigeminal ganglion and thalamus, since the condition is not caused by an intrinsic vascular compression, microvascular decompression would not be the recommended treatment for post-traumatic trigeminal neuralgia.
Thank you,
Rosabel Young, MD
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Avatar_n_tn
Thank you for your input. I do not recall the specifics of the question you are referencing. However idiopathic trigeminal neuralgia represents the most common cause for trigeminal neuralgia. As you are aware neuropathic pain can occur from damage or compression of the nerve from the brainstem to the most distal branches.
7 Comments
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Avatar_n_tn
Thank you so much for your contribution. My trigeminal neuralgia
started 4 maxillary surgeries ago. The real trigger was the
trauma from caldwell-luc procedure. My neurologist continues to
be baffled by how it presents itself. When the temple/teeth pain
start, it feels like `edema' filling my head w/ pressure. Only
sedating w/ alprazolam relieves pressure on nerve & then fluid
starts popping out my ears. Why would this neuralgia create my
strange symptom? ENT's say it's impossible. It's not an allergy.
Have you heard of this type of swelling? Last year I started ET's
& waking-trembling. Can TN cause this also? I've been told this
nerve is a huge mystery. I only know I can predict the weather.
I'm considering a teaching-clinic since MD's have no researching
time to help. Any input greatly appreciated.  *Are you w/ a
Parkinson's group? Familiar name!





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Avatar_n_tn
I have to agree with Dr. Young that MVD (microvascular decompression)normally/usually does NOT help those who have Atypical Trigeminal Neuralgia stemming from an injury to the head/face areas.

Injuries to a branch of the TN Nerve can result from Dental surgery, Sinus surgery, Plastic surgery, etc., or a blow to the face/head or a fall on the face/head area.

MVD can be helpful to those with Classic Trigeminal Neuralgia in the hands of an expert neurosurgeon who has done this procedure over and over and over again.

Trigeminal Nerve Pain can be very brutal regardless of the cause.

I was a victim of an injury and did much research in this. I did not have any kind of surgery to relieve this pain but I would of ended up in the wrong hands had I not done a lot of research.  

This pain can settle down on its own.  (6 years for me).
The key for me was not to aggravate the area for fear it would fire up again.
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Avatar_n_tn
Did you have any symptoms that effected your head pressure or ear
pain or fullness off/on. What type of Rx helped you out? You're
right about `it will start to settle over time'. The agony till
then! Dr's just said `vascular'. My only relief was Xanax to de-
stress, muscle-relaxants, Lortab & ice. If I sedate that part of
the brain that activates, spasm rests. My head pressure is something no one understands. Feels like a blood rush to my head
as if I were upside-dwn too long. N/A from neuro's & surgeons.
Help from a dentist. Massive tooth pain shot me out the door. DDS
said teeth are great, symptoms appear to be TN. Throwing that
idea out there got me drugs to help with life. Still don't have
much of one but they're humoring me. I have flare-ups but not
like 3 yrs. ago. I just wish I could find something to control
this head pressure. Attack hits & I can't leave home. Ears pop
spasms & are wet. Pressure gone. ENT's say ears don't work like
that! I decided that my Obit. is going to say thank you to: I'll
list every Dr. I saw. Maybe some will get a laugh after I'm gone. Till then I add to the list of yadda', yadda's!
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Avatar_n_tn
My intitial injury was Dental to the upper Maxillary area. It has never been determined if it was the Root Canal itself or the placement of the needle for the anesthetic or the anesthetic ingredients itself. I avoid Ephrinephine and Marcaine like I do a rattler. I avoid injections on that side of the mouth.  Any procedures now have to be without any anesthetics.  

YES, when a branch of the TN nerve is injured, pain can be felt in various distributions of that nerve.  These nerves have twigs also that can flare up causing more discomfort than an average physician can realize.

The more teeth that were pulled in hopes they were the offenders (prior to doing my own research) the worse I became. The more times I head was bent back also triggered spasms in the cervical.  

The Cervical/Occipital area can also get into the act causing horrendous amount of discomfort.

Yes, the ears can also.  

Occipital Neuralgia in my case was secondary to the original injury.  My head was killing me most of the days which brought in also the ear pain.

I saw ENT's, Neurolgists (thought I was a fruit cake) Oral Surgeons, Periodontists, Chiropractors, Orthopedics, Neurosurgeons, Physical Therapists, Pain Anesthesiologists (biggest joke) all to no avail.  I was in contact with NIH and was going to go there for a study but declined after talking via the phone with one who was there.

My life and others like me was a living hell.  My family's life was also a living hell seeing me like this.

What happens to the original injury is Neuromas can form on the injured nerve.  If these neuromas can be identified in time (very short time) there is hope for reconstruction of the damaged nerve.  (learned this out too late for me).

Neurontin is used as are other drugs which with me, most had side effects that I was not willing to add to my pain.

Some people do well on tiny amounts of Elavil taken close to bedtime that is trirated to the individual.  Some do well on Paxil but Paxil can have strong withdrawals if one gets off suddenly. Paxil and Elavil can raise the Serotonin in the brain thus lessening the pain receptors.

Some go to strong narcotics of which I would not do.  

I did what I could...when I could.  I bought those "buddies" which I warm in the microwave and used them every night.

I found a great physical therapist with a MD phsciatrist (Md Therapist..not a shrink) who worked wonders in the occiptal and cervical area to release the spasms caused by the inflammation and pain.  

I am EXTREMELY careful of what I do and how I do it.  I have a great female DDS who understands what I have been through.

Sorry for the length of this but it needs to be brought to the surface about facial nerve injuries and its ramifications.

Approximatley 5% of these injuires are caused by dental procedures.  One thinks 5% is nothing but when you calculate that millions of people go to the DDS yearly, 5% is much too high a number.

I am not advocating any meds or medical advice here as I am not a health care provider.  I am only sharing my story.

My best to you.






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Avatar_n_tn
Thank you for your info. Sounds like the same problem only yours
was caused by a DDS, my TN was DX by one. Good ones/bad ones out
there. Just like the world. I went to many `Top Docs' written up
in the paper & spent thousands to get help. Just gotta' take
charge! I tried Neurontin. Did a previous post on that one. Rx
co's. like to hook us. Head went into a seizure-mode by 3rd pill.
Guess it helps someone. $185 poof! How did you get from a virus
to a Dx of TN? Did it create some nerve damage? Your dental work
story made me cringe! Hope you're doing much better. Appreciate
you sharing.
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Avatar_n_tn
My saga began in Feb.03 I had aroot canal, was in a lot of pain and ended up having the tooth extracted - bottom left. I was in agony when I was injected and for weeks after. I had three dentist look at me  because the tooth next to the extracted one was giving me a lot of pain. They all confirmed it was not from the tooth and referred me to a neurologist. It is now Set. and I went to the neurologist in May. I have been on nortriptyline, and gabapentin with limited success. I have now begun to take tegetrol. The neurologist said it is definitely due to the dental work and I am wondering if I will ever be pain free. The pain is not as intense as it was but it is still there. Has anyone out there had this. Please tell me it gets better.
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