Trigeminal neuralgia is a cause of chronic pain in which the trigeminal nerve, which receives the sensory sensation of the face, is affected. Even activities that involve very light touching of the face, such as brushing teeth and applying make-up, can cause unbearable pain. It can start with short-term and mild attacks. Gradually, the disease may progress, the painful periods prolonging and intensifying. It usually occurs after the age of 50. It is more common in women than men. Its annual incidence is 12 per 100,000.

Symptoms

  • Severe, throbbing or stabbing pain that feels like an electric shock
  • Pain triggered by things like touching the face, chewing, talking, brushing teeth, etc.
  • The pain may become very severe for a few seconds or minutes
  • Painful periods lasting days, weeks, or months (in some people the pain is so frequent that pain-free periods are noticeable)
  • Spasm-like pain followed by a constant stinging or burning sensation
  • Pain in the cheeks, jaw, teeth, gums, lips, more rarely in the eyes and forehead
  • The pain affects one side of the face at a time, but it can rarely be bilateral.
  • Pain may be felt in a single spot or in a more widespread area.
  • The frequency and severity of attacks increase over time.

Two forms have been defined as type 1 and type 2. Type 1 is the classic type in which neuropathic pain complaints are seen, which are sudden, severe, with attacks of a few seconds or minutes. In type 2, however, the pain is less intense, but is felt as a constant tingling, burning, stinging.

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Why Does It Happen?

In trigeminal neuralgia, the function of the trigeminal nerve (5th cranial nerve), which receives facial sensation, is impaired. In general, the problem is that the nerve is in contact with a vessel at the base of the brain. This contact compresses the nerve and prevents it from working properly. Aging, multiple sclerosis and some other diseases in which the myelin sheath is damaged, a tumor compressing the trigeminal nerve, arteriovenous malformation (AVM) are other possible causes. Stroke, facial trauma, and surgical trauma can also cause trigeminal neuralgia.

Factors that can trigger pain

  • don’t shave
  • touch face
  • eating
  • drinking
  • Brushing teeth
  • Speech
  • make up
  • Don’t feel the wind
  • Laugh
  • face wash

Diagnosis

People with suspected trigeminal neuralgia are examined by a neurologist. The characteristics of the pain allow the diagnosis. Trigeminal neuralgia causes sudden, short-term, shock-like pain. It affects the regions where the trigeminal nerve receives sensation on the face. Light touching of the cheeks, chewing or even the breeze can trigger pain. In the examination, the location of the pain can be evaluated by touching the face. Thus, it can be understood which branches of the trigeminal nerve are affected. Reflex examination may provide additional information about nerve involvement. MRI can be used to examine for a possible tumor or MS disease. MR-angiography can be done to view blood vessels.

What Diseases Can It Be Confused With?

  • Post-herpetic neuralgia
  • Cluster headache
  • Migraine
  • Jaw joint disorders
  • Toothache
  • Giant cell arteritis
  • Glossofaringeal nevralji
  • Paroxysmal hemikraniya
  • Otitis media
  • Sinusitis

Treatment

Various drug treatments are available for trigeminal neuralgia. Simple pain relievers and opioid drugs are not usually effective. Anti-epileptic (carbamazepine, oxcarbazepine, lamotrigine, phenytoin, clonozepam, gabapentin etc.), antispasmodic (baclofen), antidepressant (amitriptyline, nortriptyline) drugs can be prescribed by the doctor. Medications are initially effective but may become ineffective over time as the disease progresses or as a result of tolerance. When drug therapy is ineffective, treatments including injections and surgery are recommended.

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Methods such as exercise, yoga, meditation, acupuncture and biofeedback can support drug therapy.

Botulinum toxin A injection can reduce pain.

In microvascular decompression surgery, the vessels that press on the nerve are removed. Although it is successful in relieving pain in many cases, serious complications such as facial paralysis, hearing loss, and stroke may develop. Another method is stereotactic radiosurgery, or more commonly known as the gamma knife . With radiation focused on the trigeminal nerve root, the nerve is damaged and pain is eliminated. Facial numbness can be seen as a side effect. There are different techniques such as glycerol injection, balloon decompression, radiofrequency thermal lesioning, which aim to damage nerve fibers (rhizotomy).

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