Disorders in certain nerves are often the source of facial pain. The best known and most severe is trigeminal neuralgia. The pain can sometimes manifest itself to horrendous proportions. You can find more information below.
What is trigeminal neuralgia?
Trigeminal neuralgia is characterized by an extremely strong, excruciating and stabbing pain that occurs once in the face. It is usually limited to half of the face. Attacks usually last seconds, rarely longer, and are among the most severe pain anyone can imagine. The term consists of the terms “trigeminal nerve,” the fifth cranial nerve, and “neuralgia,” meaning nerve pain.
The trigeminal nerve is responsible for sensations in the facial skin. There are two trigeminal nerves: a left and a right. In trigeminal neuralgia, either one is usually problematic and the affected area is severely sore. Rarely, both sides are affected in about three to five percent of cases.
There are two types of trigeminal neuralgia:
- The more common classic type occurs predominantly on one side. It is typical that episodes of pain are sometimes interrupted and there are symptom-free periods.
- Symptomatic (atypical) trigeminal neuralgia is very rare and develops through brain tumors, diseases such as multiple sclerosis , or inflammatory problems such as shingles . It usually occurs on both sides and causes discomfort between attacks of pain.
The disease usually occurs after the age of 40 and affects women more often than men. About six women and three men out of 100,000 are diagnosed with trigeminal neuralgia each year.
What causes trigeminal neuralgia?
In most patients, symptoms are caused by a small blood vessel pressing on the trigeminal nerve, thereby triggering pain, and this is the classic form of the disease. It can also be caused by other diseases such as multiple sclerosis, tumors, circulatory disorders or previous head injuries, and in such a case atypical trigeminal neuralgia is mentioned. Compared to the classical form, the atypical form is less common. Pain is often triggered by stimuli such as brushing teeth, chewing or taking a cold shower.
What are the symptoms of trigeminal neuralgia?
In trigeminal neuralgia, severe pain occurs suddenly on one side of the face and usually lasts for seconds to a maximum of two minutes and then disappears again. Patients usually do not feel pain between attacks. Affected individuals describe their pain as like lightning, like a knife, or like a bullet. Pain attacks can occur up to several hundred times a day. It can be felt every day for the first few weeks and months. There may also be times when they do not appear for several weeks or months.
Typical for trigeminal neuralgia is the triggering of pain attacks by trigger mechanisms. A light wind, touching the chin or cheek, brushing the teeth, or chewing can cause an attack of pain. Often the pain occurs in the area of the upper or lower jaw radiating to the cheek or jaw, so it may initially be believed that the teeth are causing the discomfort.
The pain may also be accompanied by spasmodic contraction of facial muscles called tics. After the attack of pain, redness may occur in the affected area, there may be tears, saliva and nasal discharge.
How is trigeminal neuralgia diagnosed?
Because of the typical symptoms, it is usually not difficult for a doctor to diagnose trigeminal neuralgia after questioning the patient and performing a physical examination. As a rule, additional investigations such as magnetic resonance imaging (MRI) or computed tomography (CT) are required to determine whether this is the classical type or atypical trigeminal neuralgia caused by other diseases (eg, tumors, vascular changes or nerve diseases) . If the complaints are unclear, a dentist or otolaryngologist can also help to find the cause.
How is trigeminal neuralgia treated?
Unfortunately, the pain of trigeminal neuralgia is almost unresponsive to the usual pain relievers. When prompt intervention is required, patients can be given an infusion of phenytoin for acute pain management. This substance is also used in epilepsy. The doctor may also prescribe medication to prevent the pain attacks from recurring. These are also active ingredients used in epilepsy. To be effective, they must be taken regularly and several times a day. If medications are not effective enough or are causing extreme side effects, in certain cases there is the option of relieving symptoms with surgery.
With microvascular decompression, the doctor exposes the root of the trigeminal nerve through a small opening behind the ear. A small plastic pad is designed that the doctor places between the nerve root and blood vessels to prevent further irritation of the nerve. However, surgery is not without risk and the disease may recur. There are other treatment options, such as thermocoagulation or gamma Knife therapy, where the doctor interrupts the nerve pathways to prevent the passage of pain.
Remember, your doctor will decide which medicine to take and how.
What consequences can the disease have?
As a result of intense, recurrent pain, the quality of life of patients with trigeminal neuralgia is sometimes severely impaired. Eating, talking and bathing can become so painful that patients want to do without them. These and other factors also predispose people with trigeminal neuralgia to develop severe depression.
What is the course of the disease?
The course of the disease differs from person to person. About 30 percent of patients have only one crisis in their life, while others have three or more. At first, attacks occur only occasionally, at intervals of a few weeks or months. But over time, they appear more often and also get heavier. But at night, those affected are usually symptom-free. Pain can be well relieved with treatment, but with all treatments for trigeminal neuralgia, symptoms may reappear after a long period of pain relief.