Carbatrol is more than a seizure medication. It is also approved for the treatment
of pain associated with trigeminal neuralgia.
Trigeminal neuralgia (TN) consists of attacks characterized by sudden, excruciating,
recurring, stabbing pain affecting the face.
For some, the pain may appear suddenly and disappear just as abruptly. For others,
the pain is continuous with sharp, electric-shock-like shooting pains that last
several seconds or up to two minutes. Episodes may occur for a few weeks or months
and be followed by periods of complete pain remission. Over time, the episodes may
become more frequent and the attacks more severe.
TN is more common in women than in men. It can occur at any age, but most often
affects people in their 50s.
Causes of Trigeminal Neuralgia
TN is a repetitive disorder affecting the trigeminal nerve, the nerve that conducts
sensation from the upper, middle, and lower parts of the face to the brain. The
trigeminal nerve has three branches: the mandibular (lower), the maxillary (middle),
and the ophthalmic (upper). The lower branch carries sensation from the lower jaw,
including the lower teeth, lower lip, side and front of the tongue, lower gums,
and part of the ear. The middle branch carries sensation from the upper jaw, upper
teeth and gums, upper lip, cheeks, palate, sinuses, temples, and most of the nose.
The upper branch carries sensation from the forehead, eyes, and bridge of the nose.
In most people, the cause of TN is unknown, although compression of the trigeminal
nerve by tumors or vascular anomalies may rarely produce symptoms. While the mechanism
by which the pain occurs is unknown, it may be the result of irritation or stimulation
along the nerve, and this in turn may cause the pain. Irritation may also be associated
with multiple sclerosis and tumors, which can usually be diagnosed by an MRI.
Fortunately for most patients, TN can often be effectively managed with medication.
For patients who do not experience adequate relief from medication, surgery can
usually provide long-term resolution of TN symptoms.
Diagnosing Trigeminal Neuralgia
There is no specific test for TN, but the symptoms are different from other types
of facial pain. Therefore, a patient's accurate description of the history, location,
and type of pain experienced can help lead to an accurate diagnosis.
Typical symptoms include:
- Short, sharp bursts of pain often described as feeling like an electric shock.
- Pain triggered by light skin contact such as brushing one's teeth, shaving, or chewing,
or changes in temperature.
- Pain that comes and goes. Periods of intense, sometimes disabling pain are often
followed by pain-free periods lasting months or even longer.
- Attacks that occur while awake; sleep is pain free.
Treating Trigeminal Neuralgia
The first-line treatment option for TN is medication. However, surgical procedures
may be used for patients who are unable to take medication or who fail to respond
to medication. Sometimes medications may work initially, but over time become ineffective.
Over-the-counter medications normally used for headache and pain do not work on
the pain caused by TN. One of the commonly used and prescribed medications is carbamazepine
(CBZ). It is extremely important that you follow your doctor's instructions regarding
taking your medication. The right CBZ levels are important to help manage symptoms
and potential side effects. Fortunately, long-acting forms of CBZ,
like Carbatrol, are available to make it easier to maintain your levels of medication.