Blog

Medicines for face pain

Posted on | by Dr. Jaydev Panchwagh | Leave a Comment on Medicines for face pain

Medicines for face pain treatment

Medicines for face pain treatment are generally those that are used to treat fits (convulsions, seizures). These come under the group called anti-convulsants (they numb the brain and prevent response to stimuli).

While there are many medicines that could be used, some are similar to the older versions, some are very different; and some medicines are not related at all. Acupressure, acupuncture, Ayurveda and Homeopathy have also been tried.

How do medicines act?

Basically, all act by numbing the brain. The intent is to reduce reactivity of the trigeminal nerve, but no medicine can act on just one nerve. It therefore acts on the entire nervous system, numbing it. This is the primary reason for the major side-effects of medication.

So, for most people, medication is the first line of treatment. Most of them are off-label for the treatment of facial pain. Most patients need to adjust the medication with varying combinations and dosages to get the best pain relief effect with minimal side-effects.

The following video describes the typical journey of a patient who has started having facial pain on one side of the face:

Which medicines are commonly used to treat face pain?

Among the medicines that are used for treatment of trigeminal neuralgia and face pain are

Carbamazepine/Oxcarbamazepine/Eslicarbamazepine,

Gabapentin/Pregabalin,

Phenytoin and other anti convulsants,

some antidepressants,

skeletal muscle relaxants,

anaesthetics

toxins.

These medicines have different formulations and trade names.

How are medicines to treat TN pain started?

Initially only one drug is generally started, at a small dose, then the dose is increased as necessary. If the pain continues to increase in intensity and frequency, a second or third drug may be added. Please be sure to talk to your doctor about the effect and side-effects that you experience. Please look out for rashes or itching or some other sign that you maybe allergic to the drug.

Are there any specific drugs for TN pain?

There is a new drug that is being developed specifically for trigeminal neuralgia pain. Research is still on, and it is in the planning stage.

Please be sure to talk to your doctor about the effect and side-effects that you experience.

What are the side-effects of medicines used to treat face pain?

Common side effects of Medicines used for treatment of facial pain:

Memory loss

Reduced co-ordination

Confusion

Weight gain

Loss of balance

Drowsiness

Difficulty in finding the right words

Fatigue

Irritability

Dry Mouth

Nausea etc

Can these drugs be stopped suddenly?

No. Stopping the medicines used to treat your TN pain is as challenging as starting you on them.

Because of the need to titrate your dosages, or shift to a different medication you need to know this.

We need to change dosage or type of medicine if you are not responding,   nature of pain has changed. a nerve block injection has failed or pain has recurred.

Typically, the medicines in high doses are tapered off over few weeks before stopping completely. This is especially true after you have undergone a successful MVD surgery. Dr Jaydev Panchwagh and his team have a specific protocol for tapering these drugs.

So, what can be expected during withdrawal?

Typically, one notices dizziness, nausea, increased pain, agitation, confusion, disorientation, violent dreams, tremors, irritability etc

Where can I find more information on the medicines?

We have an entire website dedicated to treatment of Trigeminal neuralgia pain. You can find information here.

Is there any alternative to medicines?

Yes, people try naturopathy, Homeopathy, Ayurveda, or Acupuncture, Acupressure and others.

Some people believe exercises help them. Some make adjustments in food.

What if medicines for treating the pain of trigeminal neuralgia have stopped working?

Do not worry! There are alternative treatments available. Nerve injections and Gamma knife procedures are nerve destructive procedures. Their effect is generally temporary. The success rate for pain relief is also less as compared to surgery.

Surgery for TN is called Microvascular Decompression (MVD surgery). It is generally a nerve preserving procedure, offers the potential of permanent pain relief. You can learn more about this here and here.

Dr Jaydev Panchwagh is the chief Neurosurgeon and Director of the Centre of excellence for MVD surgery in Pune, India. He has been keenly focused on MVD surgery for nearly twenty years and has operated on patients from more than 22 states in India, and about 13 countries around the world. He has performed more than 1900 MVD surgeries as of this date.

You can find more information on his work here.

Trigeminal neuralgia symptoms

कान और गले में दर्द

Posted on | by Dr. Jaydev Panchwagh | Leave a Comment on कान और गले में दर्द

कान और गले में दर्द होना, विशेष रूप से निगलने पर दर्द होना Trigeminal Neuralgia का संकेत (indicator) हो सकता है.

अधिक जानकारी के लिए, इन  विडियो जरूर  देखें.

Trigeminal neuralgia के लक्षण क्या है?

गाल में दर्द, जबड़ों में दर्द, दांतों में दर्द, या निगलते समय दर्द ….ये सब Trigeminal Neuralgia के लक्षण हो सकते हैं.

चेहरे की नसो में दर्द को ट्राइजेमिनल न्यूराल्जिया कहते हैं।

Trigeminal neuralgia क्या है?

चेहरे की नसो में दर्द का नाम ट्राइजेमिनल न्यूराल्जिया है. चेहरे के दर्द के कई कारण होते हैं. सबसे आम कारण ट्राइजेमिनल तंत्रिका को संकुचित करने वाली रक्त वाहिका है. (Nerve और blood vessel के बीच  compression). Trigeminal neuralgia का दर्द कैसा रहता है? trigeminal neuralgia का दर्द बहुत ही भयानक और असहनीय होता है. कभी बिजली जैसा दर्द, तो कभी चुरी चुभो रहा हो ..इस जैसा…कई प्रकार है.

चेहरे की नसो में दर्द क्यों होता है?

चेहरे का दर्द ट्राइजेमिनल तंत्रिका के संपीड़न के कारण होता है.

चेहरे की नसो में दर्द का इलाज क्या है?

चेहरे की नसो में दर्द का इलाज, पहले दवाई से की जाति है. अगर दर्द कम नहीं हुआ तो एमवीडी सर्जरी (MVD surgery) कर सकते हैं.

कान और गले में दर्द अगर trigeminal neuralgia के वजह से है तो उसका इलाज हो सकता है. पहले दवाइयों से, फिर सर्जरी से. इस सर्जरी का नाम है मिक्रोवास्कुलर डीकम्प्रेशन सर्जरी. इसके बारे में और जानकारी के लिए हमारे  Youtube चैनल देखें.

डॉ जयदेव पंचवाघ ब्रेन और स्पाइन सर्जन हैं जो इस MVD operation करने में काफी अनुभवी हैं. 

 

Microvascular Decompression Surgery

Posted on | by Dr. Jaydev Panchwagh | Leave a Comment on Microvascular Decompression Surgery

Microvascular Decompression Surgery or MVD surgery is a brain operation, commonly done to relieve nerve compression of the fifth and seventh cranial nerves. Occasionally the ninth nerve is also decompressed by itself or in conjunction with the Trigeminal nerve.

All about MicroVascular Decompression:

 

What is MVD surgery?

There are twelve nerves that arise from the brain, on each side. Of these, the fifth (Trigeminal nerve), seventh-eighth complex(Facial-Vestibulocochlear) and ninth(glossopharyngeal) nerves are prone to compression leading to hyperactivity disorders that need treatment.

What is the fifth nerve called?

The fifth nerve is the Trigeminal Nerve. The Trigeminal nerve supplies the sensation to the face. It has three divisions : V1,V2 and V3. these supply specific areas of the face on each side.

What is the seventh-eighth nerve called?

The seventh-eighth nerve complex is the Facial nerve-Vestibulocochlear nerve complex. The facial nerve supplies the facial muscles. The eighth nerve is the nerve of hearing and balance. This is the reason why in Hemifacial spasm, occasionally, either tinnitus or a clicking sound may be heard.

What is the ninth nerve called?

The ninth nerve is the Glossopharyngeal Nerve. It supplies sensation to base of tongue, tonsillar pillars and throat. There are other functions too, but this is the function most affected in glossopharyngeal neuralgia and causes pain while swallowing.

What is Microvascular Decompression surgery?

It is an operation done at the level of the brainstem, where the involved nerve exits/enters the brainstem. The blood vessel compressing the nerve is moved away from the nerve(decompressed) using a microscope/ endoscope or both. This is performed to treat Trigeminal neuralgia, Hemifacial spasm or glossopharyngeal neuralgia.

Is it possible to see a video of MVD surgery?

Certainly. Dr. Jaydev Panchwagh, chief Neurosurgeon and Director at the MVD Centre shows us how it is done. here:

If you are interested in knowing more about a video discussing diagnosis, symptoms, MRI and treatment, please click here.

Can I get a comprehensive idea about Trigeminal neuralgia?

Yes, you can read all about it on this page.

चेहरे की नसो में दर्द

Posted on | by Dr. Jaydev Panchwagh | 26 Comments on चेहरे की नसो में दर्द

चेहरे की नसो में दर्द क्या कहलाता है?

चेहरे की नसो में दर्द का नाम ट्राइजेमिनल न्यूराल्जिया है।

Trigeminal neuralgia का दर्द कैसा रहता है? trigeminal neuralgia का दर्द बहुत ही भयानक और असहनीय होता है. कभी बिजली जैसा दर्द, तो कभी चुरी चुभो रहा हो ..इस जैसा…कई प्रकार है.

इसके कई कारण होते हैं । सबसे आम कारण ट्राइजेमिनल तंत्रिका को संकुचित करने वाली रक्त वाहिका है ।

शुरू में इस बीमारी को ठीक करने के लिए दवाइयां दी जाती है..जैसे की Tegretol, Mazetol या Carbamazepine.

दर्द का वजह नस का कम्प्रेशन होता है. यह MVD surgery से ठीक हो सकता है.

ट्राइजेमिनल न्यूराल्जिया  क्यों होता है?

चेहरे का दर्द ट्राइजेमिनल तंत्रिका के संपीड़न के कारण होता है । चेहरे की नस को Trigeminal Nerve नाम  से जाना जाता है. इस तंत्रिका के तीन भाग होते हैं, जो चेहरे के ऊपरी, मध्य और निचले हिस्से को सप्लाई करते हैं.

चेहरे में दर्द , एक दुर्लभ nerve का विकार है। यह चेहरे के गंभीर दर्द का कारण बनता है.

Trigeminal nerve distribution
(pic courtesy: Wikicommons)

 

गाल में दर्द या जबड़ा में दर्द ट्राइजेमिनल न्यूराल्जिया के कारण भी हो सकता है। Neuralgia याने नस में दर्द होना. इसी लिए इस नस के दर्द के बीमारी को {चेहरे की नसो में दर्द) trigeminal neuralgia बोलते हैं.

चेहरे  की नसो में दर्द (trigeminal neuralgia) का इलाज क्या है?

चेहरे की नसो में दर्द का इलाज, पहले दवाई से की जाति है। अगर दर्द कम नहीं हुआ तो एमवीडी (MVD) सर्जरी कर सकते हैं। यह ऑपरेशन न्यूरोसर्जन करते हैं.

ट्राइजेमिनल न्यूराल्जिया का दर्द कैसा होता है?

रोगी को तेज बिजली की तरह का झटका लगता है जैसे आंख, गाल, मसूड़े या जबड़े में बिजली का दर्द ।

क्या यह कान के दर्द के रूप में भी उपस्थित हो सकता है?

हां। TN भी कान में दर्द पैदा कर सकता है; लेकिन यह ग्लोसोफेरींजल न्यूराल्जिया से भी जुड़ा हो सकता है।
यदि आप ट्राइजेमिनल न्यूराल्जिया के बारे में अधिक जानना चाहते हैं, तो कृपया इस वीडियो पर क्लिक करें ।
 
Dr. जयदेव पंचवाघ न्यूरोसर्जन हैं । वह पुणे में एमवीडी सेंटर के निदेशक (डाइरेक्टर) हैं ।

उनका अनुभव बहुत विशाल है । उन्होंने अब तक 1850 से अधिक MVD सर्जरी की हैं.

अगर आप इसका इलाज के बारे जानना चाहते हैं, तो यह विडियो आपको उपयुक्त होगा…

 

 

Is MVD surgery risky?

Posted on | by Dr. Jaydev Panchwagh | 3 Comments on Is MVD surgery risky?

Is MVD surgery risky?

This is a transcript of an interview with Dr Jaydev Panchwagh, neurosurgeon. This was aired on TV. He is the Director of the MVD Centre in Pune.

Trigeminal Neuralgia: General Information

Interviewer: Doctor, I read up some articles on Trigeminal Neuralgia before this interview. It appears that the patients are affected by a very severe kind of pain in the face.

Dr Jaydev Panchawagh: Yes!! The pain is so severe and comes so suddenly that some patients even contemplate suicide!! The pain is variously described as sharp, stabbing, burning, shock-like etc.

Trigeminal Neuralgia: Treatment choices

Interviewer: I also read that there are many kinds of treatments available, but none really effective. Is that correct?

Dr Jaydev Panchawagh: Treatment of Trigeminal neuralgia is usually started with medicines (tegretol, Carbamazepine). Initially they are effective. But over a period of time, the pain takes over. We need to increase medicine doses. The pain gets controlled. Then over the next few months, medicines lose their effectiveness. The doses need to be further increased or medicines changed. This goes on till the pain becomes unbearable or the medicine’s side effects are not tolerated. The patient then has to consider other options. But in our MVD Centre, we often give the option of surgery before very high doses of medicines are reached. Because, the side effects are at this time unacceptable.

There are other treatment options like RFLG,  nerve Blocks ,  balloon compression , or Gamma knife radiation but my particular preference has generally always been MVD surgery.

Trigeminal Neuralgia: MVD surgery

Interviewer: So, is MVD surgery a brain surgery?

Dr Jaydev Panchawagh: Yes, MVD or MicroVascular Decompression surgery is a brain surgery. The operation is performed where the Trigeminal nerve exits from the brainstem. It is in a very deep part of the brain.

Interviewer: Is MVD surgery risky?

Dr Jaydev Panchawagh: It is fairly safe in the hands of an experienced surgeon. The more MVD surgeries one performs, the more comfortable one becomes with the anatomy there. We become more aware of what to expect, what to do, what not to do. So the chances of success in the surgery also is much higher than in the hands of an inexperienced surgeon. This is one of the reasons why MVD surgery is best done at Centres which have a high volume of these surgeries. 

Why experienced neurosurgeon matters?

The patient must therefore find out how many such surgeries the surgeon has performed. The potential risks could be infection, bleeding, hearing loss, facial numbness, and/or facial weakness (generally temporary),  CSF leak, difficulty to talk/ swallow, stroke/ paralysis/risk to life (extremely rare).

Interviewer: Doctor, how many MVD surgeries have you performed so far?

Dr Jaydev Panchawagh: I have performed more than 1600 surgeries so far (from 2002 to 2022). You can access the testimonials of some of the patients here.

Interviewer: What is the aim of MVD surgery?

Dr Jaydev Panchawagh: The final goal is to prevent pain that arises because of compression of the Trigeminal Nerve either by a blood vessel or by brain tumors.

Interviewer: Is MVD performed for treatment of Trigeminal neuralgia alone?

Dr Jaydev Panchawagh: No, MVD can be performed for treatment of Hemifacial spasm ( affecting the Facial nerve) or Glossopharyngeal Neuralgia(affecting the glossopharyngeal nerve). You can know more about this in my video explaining Hemifacial spasm symptoms and causes.

“

 

 

 

You may watch this video to know more about Glossopharyngeal neuralgia .

 

What is Trigeminal neuralgia?

Posted on | by Dr. Jaydev Panchwagh | 1 Comment on What is Trigeminal neuralgia?

What is Trigeminal Neuralgia?

Trigeminal neuralgia is a chronic facial pain caused by a hyperactivity disorder of the Trigeminal nerve. In simple words, it is a symptom of Trigeminal nerve compression. This compression could be caused by a blood vessel or by a tumor, among many other causes. TN  pain is severe and is generally treated with medicines, initially.

What is the trigeminal nerve?

Trigeminal nerve is the fifth nerve which is given off from the brain. It is a cranial nerve. This is a sensory as well as motor nerve. It means that the nerve supplies sensation to the face and the motor component supplies muscles of chewing.

What is the commonest presentation of trigeminal neuralgia?

Commonly TN pain begins after some form of dental treatment, either an extraction or root canal work. However, the dental work actually is only a trigger, not the cause. Other triggers for the trigeminal neuralgia pain are brushing, eating, talking, shaving, touching etc.

Can Trigeminal neuralgia be associated with ear pain?

Yes. TN itself can cause ear pain; but it may also be associated with Glossopharyngeal neuralgia which can also be the cause of ear pain.

How is the pain of Trigeminal neuralgia?

The patient has severe electric shock like or lightning like pain in the eye, cheek, gums or jaws. Mostly, this disorder is diagnosed late. Thus the patient suffers for many years before they are told their diagnosis. It is frequently mistaken for migraine, dental pain or ear pain. MRI is performed to support the clinical diagnosis.

Can MVD be done after RFLG?

Yes, but a primary MVD always gives better success. Radio Frequency Lesioning or ablation of the trigeminal nerve is a destructive procedure. MVD surgery is a nerve-preserving procedure.

Who performs the MVD surgery?

MicroVascular Decompression (MVD) surgery is a brain surgery and is performed by a neurosurgeon. An experienced neurosurgeon gives the best results, better success rates and lower chances of risks.

Can we get any patient testimonials or their experiences?

Sure. Please click here to read and watch videos of patient experiences. All these patients have been operated by our team, at the MVD Centre. You can click here to read more Frequently Asked Questions on Trigeminal neuralgia and MVD surgery. You can visit the home page of this website on trigeminal neuralgia treatment by clicking here.

Who runs the MVD Centre?

The MVD centre is in Pune. The Director is Dr Jaydev Panchwagh, who has an experience of more than 30 years in the field of neurosurgery. His passion in the specialty is MVD surgery.

 

Symptoms of Trigeminal neuralgia

Posted on | by Dr. Jaydev Panchwagh | Leave a Comment on Symptoms of Trigeminal neuralgia

Symptoms of trigeminal Neuralgia:

Symptoms of trigeminal Neuralgia are generally electric shock-like pain in the face. This could be in the forehead, eye, cheek, nose, upper or lower jaw areas.

What are the triggers for face pain or trigeminal neuralgia?

Typically the triggers that set off an episode of Facial pain are touching, brushing, shaving, chewing and talking.

 

 

How does an attack of Trigeminal Neuralgia look like?

This pain is so severe and horrible that it is called the suicide disease! Watch this video to see how the TN attack looks.

Can Trigeminal neuralgia pain be treated ?

The good news is, Yes!!  Though medical treatment is the mainstay, especially in the initial phases of the disease, medicines soon become ineffective. Occasionally, the patient has a pain holiday and comes to believe that his/her pain has been cured. But it comes back with a vengeance, and this is the time that most patients usually seek permanent treatment.

Do I need to visit a neurologist or neurosurgeon to treat Trigeminal Neuralgia?

Initially, after the diagnosis of Trigeminal neuralgia is made, the patient is referred to a neurologist, to start medical therapy. The neurologist adjusts the doses as necessary, and helps the patient understand how to time the doses to get best pain relief. The neurosurgeon is involved when the patient no longer finds medication useful, or when the side-effects of medicines are unbearable. The neurosurgeon then offers Microvascular Decompression surgery as a possible permanent treatment.

Is Dr Jaydev Panchwagh an MVD Specialist?

Yes. Dr Jaydev Panchwagh is a neurosurgeon practising in Pune, Maharashtra. He is passionate about treating Trigeminal neuralgia and Glossopharyngeal Neuralgia. With the aim of focusing on the treatment of this deadly pain, he has been instrumental in putting together a dedicated team. He is the Founder-Director of the Centre Of Excellence for MVD surgery. It is perhaps the only one of its kind in India.

Trigeminal Neuralgia-living and leaving. My story

Posted on | by Dr. Jaydev Panchwagh | 1 Comment on Trigeminal Neuralgia-living and leaving. My story

Trigeminal Neuralgia-living and leaving. My story.

In this story, the patient describes how he had severe pain, how he was resigned to accepting his fate, living with the pain, and how MVD surgery was a life-changing experience for him.

Why a Trigeminal Neuralgia specialist?

Trigeminal Neuralgia treatment in India is well established, especially for medical management. There are a few neurosurgeons who perform MVD surgery for treatment of trigeminal neuralgia; Dr Jaydev Panchwagh is a trigeminal neuralgia specialist doctor who is Director of the centre of excellence for MVD surgery. He has an experience of more than 1400 MVD surgeries in the last 20 years.

Trigeminal neuralgia attack and its treatment

Posted on | by Dr. Jaydev Panchwagh | 12 Comments on Trigeminal neuralgia attack and its treatment

Trigeminal Neuralgia attack and its treatment

Trigeminal Neuralgia attack can be very severe and frequent as the disease progresses, and its treatment at that point in time may be very frustrating. It is when such attacks become frequent that the patient generally tend to take decisions about getting MVD surgery done. In this video, a patient shares her experience during one such attack and how she suffered through it. She also describes how her life changed for the better after she became pain-free after MVD surgery. Dr Jaydev Panchwagh, an eminent neurosurgeon and an internationally acclaimed one performed this Microvascular Decompression (MVD) surgery on her. Having performed more than 1350 MVD surgeries, at his MVD centre in Pune, India, he has a considerable experience in treating Trigeminal Neuralgia. The MVD centre also caters to international patients and has a support group.

Is Trigeminal Neuralgia serious?

The honest answer is yes and no. By itself it does not harm life, (except in cases of C-P angle Tumor) but the disease itself can be so debilitating, and its medical treatment so very challenging, that the patient often considers ending their life because of the pain and the fear of an upcoming TN attack. Click here to read more about the disease.

Trigeminal Neuralgia (Facial Pain) diagnosis

Electric shock-like pain in any or all of the three divisions of the trigeminal nerve brought about by trigger factors usually establishes the diagnosis of trigeminal neuralgia.

Trigeminal neuralgia causes

The pain of trigeminal neuralgia is usually caused by one or more blood vessel compression on the trigeminal nerve or a C-P angle tumor (Cerebellopontine angle tumor). There can of course be other causes. Click here to know more.

 

Trigeminal Neuralgia attack

The pain in Trigeminal neuralgia manifests as attacks of facial pain generally brought about by trigger factors like talking, brushing teeth, eating etc. The patients experience electric-shock like pain during the trigeminal neuralgia attack. The pain may have different manifestations in different people. click here to know more about Trigeminal neuralgia symptoms.

Trigeminal neuralgia treatment

Though there are many options for treatment of Trigeminal neuralgia including medications, Radiofrequency lesioning (RFLG) etc, Microvascular decompression surgery is the only shot at achieving a possible permanent cure.