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Dr. Mericle is the Director of Cerebrovascular and Endovascular Neurosurgery at Vanderbilt Medical Center. He is the Residency Program Director for Neurosurgery and Co-Director of the Vanderbilt Multidisciplinary Stroke Center. His clinical interest is in all aspects of Neurovascular Surgery and Brain Tumor Surgery, including both open and minimally invasive surgery for Intracranial Aneurysms, AVMs, Trigeminal Neuralgia, Carotid Stenosis, Spinal AVMs, and Skull Base Surgery.
Dr. Robert Mericle
How do you know if you have trigeminal neuralgia?
“How do you know if you have trigeminal neuralgia?”
“Classic trigeminal neuralgia is best diagnosed by the patients, by the patient’s history. There’s not really any scans or MRI’s or tests that you can do that prove you have trigeminal neuralgia. Sometimes it will give us a hint or help us one way or the other and a MRI scan is useful or a CT scan is useful, either one of them, in a patient with trigeminal neuralgia because you want to make sure there is nothing else going on but it doesn’t diagnose trigeminal neuralgia.”
“You know you have trigeminal neuralgia by answering seven questions. There’s briefly, they are: what does it feel like (what does the pain feel like), how bad is the pain, the onset or how quickly does it come on (does it come on suddenly or slow), how long does it last, where is it located, what makes it better, what makes it worse.”
“If you have trigeminal neuralgia, the answers to those seven questions are the quality of the pain is a sharp, stabbing. Sometimes it is described as an electrical shock type pain. It feels like a live wire burning. Some people have a burning component as well.”
“The severity of the pain is almost always described as the worst pain they have ever had in their life – especially if you are not taking the medications it is the worst pain you can ever have. Matter of fact, most experts would agree it is the worst pain known to mankind without any treatment.”
“The third question, the onset of it, is a quick onset, a rapid onset. Unlike for example headache pain that can gradually build up over hours or even the whole day, trigeminal neuralgia hits you suddenly. It is a sudden burst of pain.”
“The next question is duration. Classic trigeminal neuralgia generally doesn’t each episode generally doesn’t last too long. It usually only lasts a few seconds. It is a burst of pain lightening bolt kind of pain that just hits you and gradually eases off. Sometimes the burst of pain can only lasts a few seconds and it can ease off maybe over a minute or so. Sometimes before it has had time to ease off, it will hit you again and you can have multiple episodes all in a row and it can feel like one episode and that happens sometimes.”
“The fifth question is location and that is very important. Obviously trigeminal neuralgia has to be in the face. It generally stays on one side although it is possible to have pain on both sides. You don’t generally have pain in the back of the head or the neck or other areas. It is only in this area of the face. It’s usually either in V1 up here including the eye, V2 is in this area right here the nose and upper lip, and V3 is right here kind of where a beard would grow if you were a man and had a beard.”
“The sixth question is what makes the pain better. Classic trigeminal neuralgia almost always gets better with the anti-epileptic drugs like Tegretol, Trileptal, Neurontin, Dilantin, Lyrica – those type drugs. It’s rare although it does sometimes also get better with narcotic medications but that’s not nearly as common.”
“And the last question is what makes the pain worse. Trigeminal neuralgia is classically triggered pain. So if you touch the face, it will trigger it. Sometimes cold wind blowing against the face will trigger it. Sometimes chewing or talking or certainly eating or brushing your teeth is a big one. A lot of people say they can’t brush their teeth because it triggers their pain so badly.”
“If you those answers to those seven questions then almost certainly its classic trigeminal neuralgia and you would be an excellent candidate for treatment.” Copyright, 2008, Face the Pain