DEAR DR. ROACH: My husband suffers from trigeminal neuralgia. This is often very painful for months at a time, then the pain will stop for a few months before it begins again. He does not want to begin taking an antiseizure medication. Are there any natural remedies? — B.K.

ANSWER: Trigeminal neuralgia is a pain syndrome involving the trigeminal nerve, which provides the sensation to the face in three bands, called divisions of the nerve: the eye and scalp, upper jaw and nose, and lower jaw and ear.

The pain of trigeminal neuralgia tends to be intermittent, coming in spasms, which can occur infrequently or many times daily. The pain is often described as being like an electric shock or stabbing sensation. However, some people have continuous pain, and the quality may be described as burning. Touching specific areas of the face may trigger a spasm of pain. The diagnosis of trigeminal neuralgia is frequently delayed, as physicians and dentists may not recognize the pain as coming from the nerve.

Your husband’s experience — episodes lasting for weeks to months followed by a pain-free interval, lasting months to years — is also very common.

First-line treatment are medications that slow down the firing of nerve cells by blocking the sodium channel. Although these medicines can be used to treat of seizures and are approved by the Food and Drug Administration for this purpose, they have a well-established role in pain management, too. Carbamazepine, oxcarbazepine and gabapentin all are medications that have been studied for treatment of trigeminal neuralgia. I am unaware of any herbs or other materials found in nature that are effective, with the possible exception of injected purified botulinum toxin (Botox and others), made by bacteria, with some evidence to support its use in people who do not respond to first-line therapies.

The cause of trigeminal neuralgia in many people is compression of the nerve deep in the brain. People who do not respond to medication sometimes are offered surgery if a compression is found by MRI scan. Surgery is not a guarantee of cure. It may have only temporary benefits, and can be complicated by hearing loss or numbness.

I’d recommend you and your husband take a look at some websites that offer further information and support groups: livingwithtn.org, fpa-support.org, and tnnme.com, all sites I recommend.

DEAR DR. ROACH: Is there any research that people born via in-vitro fertilization have increased long-term health issues? My 30-year-old daughter was born via in-vitro and was healthy until she reached puberty. Then her hormones went haywire and she started having benign breast tumors, then asthma, then appendicitis, now thyroid problems. She went from being small for her age to overweight. I just wonder if the drugs her mother took to make in-vitro possible had some long-term effect? — S.T.

ANSWER: There are some health issues associated with assisted reproductive technologies such as IVF. However, the best known of these are related to early development, including a small increase in congenital abnormalities, low birth weight and pregnancy loss. The neurological and developmental outcomes of children conceived by IVF and other technologies appears to be no different from children from spontaneous pregnancies.

I did read one report of children from IVF having early puberty, but it is not clear that the risk of early puberty is higher overall. Asthma, appendicitis, breast tumors and thyroid issues are very common in teens and young women, as are weight problems. Based on my reading, I doubt the IVF had anything to do with it.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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