Trigeminal neuralgia: symptoms, causes and treatment

There are few pains that cause as much disability and discomfort as pain related to the ear or toothaches. Luckily for the person who suffers from them, these are temporary and can be easily remedied.

Now, let's imagine that these pains appear randomly and chronically and that, furthermore, the treatments could not make the pain go away permanently. This is what happens in trigeminal neuralgia, a very painful disorder which we will talk about next.

• Related article: "Cranial nerves: the 12 nerves that exit the brain"

What is trigeminal neuralgia?

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

Among the effects that trigeminal neuralgia causes in the person is a sensation similar to that caused by burning, which appears suddenly and fortuitously (Type I); In addition, these patients may also experience a sensation of intense, stabbing pain that can last up to two minutes (Type II). Hence, this disease is also known as tic pain.

The pain caused by this condition can become so intense that the person is practically incapacitated both physically and mentally.

To fully understand this condition, it is necessary to know that this trigeminal nerve is part of the twelve pairs of cranial nerves that start 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 to the oral cavity. This nerve is formed by three branches:

• The ophthalmic or superior branch transports the sensations to almost the entire scalp, forehead and frontal area of ​​the head.
• The maxillary or middle ramus it passes through the cheek, the upper jaw, the upper lip, the teeth, the gums and the sides of the nose.
• The mandibular or inferior ramus that runs through the jaw, teeth, gums and lower lip.

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

• Related article: "The 13 types of pain: classification and characteristics"

What symptoms does it present?

As previously mentioned, the symptoms associated with trigeminal neuralgia are distinguished for causing in the patient a sharp and excruciating suffering or pain, similar to an electric shock that usually felt on the side of the jaw or on the cheek.

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

• Contractions that cause very intense pain, such as an electric shock, lasting up to two minutes and can occur constantly.
• Usually pain only appears on one side of the face. Specifically in the eye, the cheekbone and the lower part of the face.
• When the pain appears, there is no subsequent numbness and nor is the ability to move the affected area of ​​the face lost.

In most cases, patients can anticipate the appearance of the episode since this tends to be preceded by sensations of tingling, stiffness, or a sensation of mild but painful pain keep going.

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

Although trigeminal neuralgia does not per se pose a risk to a person's health, the pain it causes can be highly disabling, causing that the person refuses by all means to carry out those daily tasks that may cause a new crisis.

What causes this type of neuralgia?

Although in many cases the cause of trigeminal neuralgia remains undetermined, there are a series of situations and diseases that favor the appearance 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 due to the normal aging process itself or due to the presence of a tumor.
• Multiple sclerosis (MS) or other diseases that cause deterioration of myelin.
• Injury to the trigeminal nerve due to trauma or oral or sinus surgery.

How is it diagnosed?

At the moment, 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:

• Medical history examination of the person.
• Description of symptoms.
• Physical exam.
• Comprehensive neurological exam.
• 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 that has the ability to permanently eliminate 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. drug therapy

There are certain medications that tend to reduce pain and the number of attacks. Among these medications are:

• Anti-seizure medication: is the most effective and may include carbamazepine, topiramate or gabapentin.
• Administration of opioids such as methadone when neither anticonvulsants nor surgery work.
• Treatment by using low doses of antidepressants like nortriptyline.
• Derivatives of morphine such as dolantine.
• botox injections on the nerve

2. Surgery

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

The main practice that is carried out in trigeminal neuralgia is microvascular decompression (MVD), whereby the surgeon places an element between the nerve and the blood vessel that makes pressure.

Other strategies consist of undoing or sectioning some areas of the nerve root using the following techniques:

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

3. other remedies

The person affected by trigeminal neuralgia can also benefit from the effects of alternative treatments such as acupuncture or chiropractic combined with medication, because of suggestion. Likewise, the use of capsaicin creams, the modification of eating habits or the Cyanocobalamin supplements may also be helpful in lessening the intensity of symptoms.