Trigeminal Neuralgia
Ronald Brisman, M.D.

Emergency Management Trigeminal Neuralgia

Emergency Management Trigeminal neuralgia

When is trigeminal neuralgia an emergency?

Trigeminal neuralgia can become an emergency when the pain is so agonizing that the patient can’t eat or talk and finds the pain to be unbearable. An emergency situation is occurring if the pains are sustained so that the patient cannot take in adequate nourishment and hydration.

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What is status trigeminus

Status trigeminus refers to continuous paroxysms of face pain. The pain does not subside. It can be a true emergency.

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How can you PREVENT trigeminal neuralgia from becoming an emergency?

If you know that you have trigeminal neuralgia and have been given medicines for it, it is very important that you keep taking these medicines as advised by your doctor. When there is a recurrent episode of trigeminal neuralgia, it is often difficult to eat or swallow and it can even be painful to swallow a pill. But if you stop taking your anti-trigeminal neuralgia medicines, the pain of trigeminal neuralgia can spiral out of control. It may help if you put the pill on the side of the mouth that does NOT have pain and try to put water and swallow on that side leaning slightly to the side that is without pain. Also, if you wait perhaps 30 to 60 minutes, the attack of trigeminal neuralgia may subside and then it would be easier for you to swallow the pill. It is also important that you have a doctor who is knowledgeable in the treatment of trigeminal neuralgia and accessible so you can contact him. During a time when your trigeminal neuralgia is NOT out of control, you should talk to your doctor about what to do if the trigeminal neuralgia gets worse, such as increasing your medicines before an emergency develops. 

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What should you do if you really have a trigeminal neuralgia emergency?

Go to a local emergency room so you can get pain medicines and intravenous (in the veins) fluids for rehydration. As soon as possible, contact a doctor who is knowledgeable in managing trigeminal neuralgia. The problem with most emergency rooms is that many of the healthcare professionals there are not expert in managing trigeminal neuralgia. They will often give you narcotics, which are not very effective for trigeminal neuralgia and will cause many unpleasant side effects including sedation, nausea, vomiting, constipation, impaired balance, impaired mental capacity and dizziness.

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Is there an effective medicine for trigeminal neuralgia that can be given intravenously?

Yes. Fosphenytoin (Cerebyx) can be given intravenously and is often helpful for managing an emergency situation with trigeminal neuralgia where the patient cannot swallow a pill. But it can cause an irregular heartbeat and has to be administered slowly while the patient’s electrocardiogram and blood pressure are being monitored continuously.

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Is emergency surgery needed to treat trigeminal neuralgia?

It is rare for surgery to be needed as an emergency to treat trigeminal neuralgia, which usually can be managed out of the hospital once the patient takes adequate oral medicines and nourishment. After the emergency has passed, patients who remain with pain or bothersome effects of medicines can be scheduled for an elective surgical procedure to relieve their pain.

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How can patients with trigeminal neuralgia protect themselves from natural disasters such as hurricanes and power outages?

Natural disasters such as the recent “Sandy” hurricane in the Northeast are unpredictable and can result in temporary loss of power and many things we take for granted including medicines. Patients with trigeminal neuralgia should always have at least a two-week supply of their medicines. Don’t wait until your last pill before you get a refill. You should also have a supply of liquid nourishment, such as Ensure, in case there is a severe flare-up of the trigeminal neuralgia and eating becomes difficult. Patients should have access to a physician (his telephone number and e-mail) who is available and knowledgeable in the treatment and management of trigeminal neuralgia.

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