Trigeminal neuralgia: symptoms, causes, diagnosis and treatment

There are few pains that cause as much disability and discomfort as ear pain or toothache. Fortunately for the person who suffers from them, these are temporary and can be easily corrected.

However, we imagine that these pains appear fortuitous and chronic and that, moreover, the treatments could not make the pain disappear permanently. This is what happens in trigeminal neuralgia, a very painful disorder which we will discuss below.

    What is trigeminal neuralgia?

    The condition known as trigeminal neuralgia it is a chronic and poignant suffering caused by an alteration of the trigeminal nerve or the fifth cranial nerve. This trigeminal nerve is one of the longest nerves in the skull.

    Among the effects that trigeminal neuralgia causes on the person is a sensation similar to that caused by the burning, which appears suddenly and fortuitously (Type I); in addition, these patients may also experience a sensation of severe, stinging pain lasting up to two minutes (type II). Hence, this disease is also known as Tic painful.

    The pain caused by this condition can be so severe that the person she is practically unfit physically and mentally.

    To fully understand this condition, it is necessary to know that this trigeminal nerve is one of the twelve pairs of cranial nerves that originate from the base of the skull. Its function is to transport sensations between the brain and the upper, middle and lower areas of the face and oral cavity. This nerve is made up of three branches:

    • The ophthalmic branch or upper transports sensations over almost the entire scalp, forehead and front area of ​​the head.
    • The maxillary or middle branch it crosses the cheek, upper jaw, upper lip, teeth, gums and sides of the nose.
    • The mandibular or lower branch that crosses the jaw, teeth, gums and lower lip.

    In trigeminal neuralgia, more than one nerve branch can be affected, causing severe pain in any of the areas mentioned above.

      What are the symptoms?

      As discussed above, the symptoms associated with trigeminal neuralgia are distinguished by causing the patient a sharp or sharp pain or suffering, similar to an electric shock that it’s usually felt on one side of the jaw or cheek.

      These pain episodes can occur on either side of the face. However, they never manifest from both sides at the same time. The full symptomatology that may appear in trigeminal nerve neuralgia includes:

      • Contractions that cause very severe pain, As an electric shock, lasting up to two minutes and may occur continuously.
      • Usually pain only appears on one side of the face. Specifically in the eye, cheekbone and lower part of the face.
      • When the pain appears, there is no subsequent numbness and the ability to move the affected facial area is also not lost.

      In most cases, the patient may come to anticipate the onset of the episode as this tends to be preceded by tingling sensations, stiffness, or a slight but continuous sensation of pain.

      One of the main characteristics of this symptomatology is that it appears suddenly and randomly. However, these incidents can be triggered by vibration or cheek contact caused by any daily action such as brushing your face or teeth, eating, or even talking.

      Although trigeminal neuralgia in itself does not pose a risk to a person’s health, the pain it causes can be very debilitating, causing that the person refuses by all means to accomplish the daily tasks likely to provoke a new crisis.

      What causes this type of neuralgia?

      Although in many cases the cause of trigeminal neuralgia remains undetermined, there are a number of conditions and diseases that lead to the onset of these episodes of pain so characteristic.

      The contexts in which it can appear are:

      • Trigeminal nerve compression by a blood vessel: this compression can occur either by the normal aging process itself, or by the presence of a tumor.
      • Multiple sclerosis (MS) or other diseases that cause myelin to deteriorate.

      • Injury to the trigeminal nerve due to trauma or surgery to the oral or paranasal sinuses.

      How is it diagnosed?

      So far, no specific test has been developed for the diagnosis of trigeminal neuralgia.

      The steps to follow to make an accurate diagnosis of trigeminal neuralgia are:

      • Exploration of medical history of the person.
      • Description of symptoms.
      • Physical examination.
      • Comprehensive neurological examination.
      • Carrying out neuroimaging studies to rule out the action of a brain tumor or multiple sclerosis.

      What is the treatment and what is the prognosis?

      As with the diagnosis, no treatment has yet been discovered capable of permanently eliminating the pain caused by trigeminal neuralgia.

      However, there are several treatments or interventions that can significantly improve the patient’s situation. These treatments are drug therapy, surgery, and other treatments or remedies.

      1. Pharmacological therapy

      Certain medications usually help reduce pain and the number of seizures. These drugs include:

      • anticonvulsant drug: It is the most effective and may include carbamazepine, topiramate, or gabapentin.
      • Administration of opioids such as methadone when neither anticonvulsants nor surgery work.
      • Treatment using low doses of antidepressants like nortriptyline.
      • Morphine derivatives such as dolantine.
      • Botox injections in the nerve.

      2. Surgery

      A second option is the solution using certain types of surgeries. However, the effectiveness of its results is widely discussed by the medical community.

      The main practice in trigeminal neuralgia is microvascular decompression (DMV), where the surgeon places an element between the nerve and the blood vessel that exerts pressure.

      Other strategies include undoing or severing certain areas of the nerve root using the following techniques:

      • Glycerol injection.
      • Radiosurgery.
      • Radiofrequency ablation.
      • Microcompression with percutaneous balloon.

      3. Other remedies

      The person with trigeminal neuralgia may also benefit from the effects of alternative treatments such as acupuncture or chiropractic combined with medication, due to suggestion. Likewise, the use of capsaicin creams, modification of eating habits, or cyanocobalamin supplements may also be helpful in reducing the intensity of symptoms.

      Leave a Comment