Coping with Those Cranial Lightning Bolts-Trigeminal Neuralgia

Dear Pharmacist,

I get weird head pain called “trigeminal neuralgia” and it’s related to mild Multiple Sclerosis.  I need some information, please answer me I am in a lot of pain. What are the available treatments? -J.S., Portland, Oregon

Trigeminal neuralgia or TN causes lightning bolt shots of pain in the head that just come out of nowhere, starting near the ear and move around your head, teeth, jaw and eye. The pain is usually one-sided but it can be bilateral, especially if you have Multiple Sclerosis. People with MS are much more likely to develop TN.
For some people, the shocks last a few seconds or a minute, then retreat until the next attack. For those who have atypical facial pain (AFP) or atypical TN, the pain varies but remains constant. It feels like someone plugged your nerves into an electrical socket and then stuck an ice pick in your eye. You must not give up, there are ways to gain control over your pain. Make sure your doctor has thoroughly tested you. There are many treatments and procedures available that can take the pressure off the trigeminal nerve. Here is some information, and if any of you have more ideas, feel free to email me so I can pass them along.

1. Medications slow down the electrical firing in your brain and therefore reduce or eliminate TN pain for some people. Neurologists often use anti-epileptic drugs such as Tegretol (carbamazepine), Neurontin (gabapentin) and Dilantin (phenytoin) among others. Baclofen and Zanaflex are other considerations.

2. If you have Multiple Sclerosis, your facial neuralgias could be related to a process called demyelination, a big word for what happens when nerve cells (neurons) lose their outer coating – their ‘insulation.’ When neurons “demyelinate” a lot of weird nervous system problems results, for example, sensations of hot water pouring down your leg, or someone pulling one of your toes.

3. Certain OTC supplements may nourish neurons and may help re-insulate you. Ask your neurologist about methylcobalamin, DHA (docosahexanoic acid, a fish oil extract), vitamin D, SAMe, NAC, progesterone, coenzyme Q10, GABA, magnesium, Methyl Guard and Brain Sustain.

4. Run a hand towel under hot water and then lay it over your face, but leave your nose free to breath (!) then apply pressure to each side of your face.

5. Apply capsaicin cream to your face/head where it hurts and whenever the ‘hot’ sensation is gone, reapply it…usually every 3 – 6 hours. This should numb nerve endings within a week or two. Avoid eye area and wash hands well. These types of creams are sold over-the-counter at pharmacies nationwide, under such brand names as “Zostrix” for example, and many store-brand generics.  Many chiropractors offer a similar type of pain-relieving gel, just make sure the active ingredient is capsaicin.

6. Ice packs or hot packs, whichever feels better.  Most people feel the cool sensation is best, but this is very personal.

7. In states where it is legal, cannabis (yes, marijuana) is used to control intractable, unrelenting pain. It’s called “medicinal marijuana” and you can just google that term to learn more about it’s use for TN, and other facial neuralgias.  In states where it is not legal, a pain specialist must write a prescription for it as “Marinol” sold in pharmacies nationwide.  Marinol is not exactly marijuana, it’s a slightly warped drug version but it has a similar effect on the body.  The herbal ingredients in marijuana stimulate receptors in the brain and may abort an attack within minutes.  Don’t stand in judgement of this illegal drug; I’m sure many of you are reading this who do NOT suffer from TN can’t understand why I’ve even mentioned this substance, and why the newspapers put it to press.  For many people, this natural herb has kept them from killing themselves, because it works that well and the pain can be so bad.  Remember, Trigeminal Neuralgia goes by another name, “The Suicide Disease.”  In case you are wondering, I do NOT have TN, nor have I ever had a facial neuralgia, but I know people that do.

8. Acupuncture helps some people, particularly with chronic pain, not so much acute episodes.
9. Get a gluten and casein antibody blood test. Removing offending allergenic foods will allow your nerves to remyelinate. This could ultimately be the cure, but it could take 3 to 6 months before the pain starts to lift where you notice it.  Stick with it!10. See your physician routinely for lab work, especially if you take medications.  Some of the anti-seizure medications that I’ve listed above are drug muggers of B vitamins.  You should read my book, Drug Muggers for more on that.  Click on the tab “store” to access that.

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2010-03-29T17:41:26+00:00