Who suffers from trigeminal neuralgia knows it: the pain it causes is of such intensity that it is not surprising that classical medicine spoke of it as the “suicide disease” The worst pain in the world that comes to condition the lives of those who suffer from it in such a way that depression, states of anguish and anxiety are common …

What is trigeminal neuralgia?

Trigeminal neuralgia is a  very intense facial neuropathic pain that typically affects only one side of the face and that has its origin in an alteration of the normal function of the trigeminal nerve or fifth cranial nerve (V in Latin). We call it that because it is made up of three branches: the first is the Ophthalmic Nerve (V1), which extends through the area of ​​the eye orbit and up to the scalp. The other two branches are V2 or Maxillary Nerve that gives the sensitivity of the skin from the temple towards the upper jaw and upper lip and finally V3 or Mandibular Nerve that gives the sensitivity of the skin in front and above the ear towards the lower jaw up to the lower lip and chin.




Always up to the middle of the face, not beyond or to the opposite side. These nerves provide sensitivity as we have just described and in addition, the Maxillary N (V3) controls the force of the muscles responsible for chewing on each side of the face.

Symptoms of Trigeminal Neuralgia

Symptoms vary from patient to patient. In most cases the pain is described as an electric shock or a stab, brutal in intensity and of short duration,  which affects  only one side of the face and is suffered in  different areas depending on the branch / s that be responsible for the pain  (see above). In practice, the most common is pain in the V2 + V3 branches together. When only one branch is affected, V2 is the most frequent.

In typical trigeminal neuralgia the facial pain is NOT continuous but in crisis (as I have already mentioned), in other patients there is permanent “base” pain with more painful episodes.

On many occasions, it comes to condition people’s lives so much that … classical medicine speaks of trigeminal neuralgia as ” the disease of suicide “. You can get an idea of ​​what this pain means …

Many patients begin suffering from short and not very intense episodes of pain that with the passage of time become more and more intense, frequent, and prolonged over time.

In other patients, the pain is unbearable from the first outbreak.

Some people suffer these episodes of pain every day for weeks, months … And in other cases, the crises occur much more widely in time.

The duration of outbreaks of pain is highly variable: from a few seconds to several minutes. It is common for the attacks to recur several times throughout the day. They generally do not appear at night -when patients sleep- which allows them to rest.

In some people the pain is spontaneous. In others, it appears with the mere friction or change of temperature in certain areas of the face. Your doctor may refer to them as “trigger points” or “trigger points.” If you suffer from trigeminal neuralgia, you will know what they are in your case. And you will even have localized some of its triggers: pain appears when performing such everyday acts as eating, yawning, laughing, washing your face or teeth.

The trigeminal nerve branches are responsible for the sensitivity and touch of most of the face. In some patients, the slightest touch or a sudden change in temperature triggers the appearance of a pain crisis.



Causes of Trigeminal Neuralgia

Your doctor will not always be able to determine the origin of your trigeminal neuralgia: it will be an idiopathic or Primary Trigeminal Neuralgia, that is, with no known cause. This is so in the majority of patients.

In this case, when an abnormality or disease that is causing the pain is ruled out, neuralgia is thought to be  related to vascular compression of the Gasser’s ganglion (a nerve ganglion is a collection of neurons. From this ganglion, which is inside the skull just behind the orbit, the 3 branches divide)

In some patients, however, the pain appears as a consequence of a disease in which the myelin sheath of the nerve is lost: Multiple Sclerosis can occur with this type of pain. Also, some tumors when compressing the nerve can cause pain.  In both cases, we speak of Secondary Trigeminal Neuralgia.

In some people, pain distribution similar to trigeminal neuralgia appears after suffering dental problems or complications from a traumatic tooth extraction or maxillofacial surgery involving a partial injury to a branch of the nerve.

More rarely, it occurs after a facial rash caused by the herpes zoster virus (postherpetic neuralgia). In other cases, also rare, it appears after an accident – a blow – in which the trigeminal nerve has been injured.

And its possible genetic origin is being studied.

To prevent the pain from becoming chronic, it is very important to have an early diagnosis of trigeminal neuralgia

Unfortunately, patients can go years without a proper diagnosis. There is no specific test to diagnose trigeminal neuralgia and it will be your symptoms and the physical and neurological examination in addition to your medical history that will guide your diagnosis.

It is important to request an MRI or MRI precisely to rule out brain disease, a tumor, and to assess a possible vascular compression of the nerves.



Its diagnosis is not easy: trigeminal neuralgia can be confused with other problems that also cause facial pain such as post-herpetic neuralgia, cluster headache …

Trigeminal neuralgia cannot be prevented. It is more common to appear after 50 years of age and is associated with aging

Treatment of trigeminal neuralgia

Its treatment is not simple and in some cases, current medicine is not able to relieve or provide a lasting solution to patients

Once the possible causes of your trigeminal neuralgia have been studied, your doctors will propose different treatment routes starting with the pharmacological one with Carbamazepine -which is an antiepileptic- to try to control your pain. It is controlled in 70% of treated patients.

They may also resort to other similar drugs such as Oxcarbazepine (with similar efficacy) and / or more recently Eslicarbazepine and other antiepileptic and antidepressant adjuvants that seek to reduce the activity of the trigeminal nerve.

If drug treatment is not enough to control it, or if the patient suffers intolerable side effects with the doses necessary to do so, the Pain Units may recommend interventional techniques for selective blockade of the nerve branches with conventional radiofrequency or pulsed -which provide temporary relief but generally of long evolution- as a previous step to other larger neurosurgical treatments such as vascular decompression of the blood vessel that is affecting the nerve (Janetta microvascular decompressive surgery), stereotactic or gamma radiosurgery- knife, balloon compression of the Gasser ganglion and finally, in some selected refractory cases, neuromodulation.

In addition to the possible complications that any surgical procedure has, the pain relief of these treatments is neither complete nor permanent for all patients. Sometimes the pain returns after a time of relief. Sometimes even with greater intensity and frequency than before the intervention …

Alternative and “natural remedies” for trigeminal neuralgia

On the Internet, you can find unverified information about many “natural”, “alternative” or “complementary” treatments for trigeminal neuralgia.

None of them have shown any efficacy …

Neither homeopathy, nor magnetotherapy, nor chiropractic, nor reiki, nor Bach flowers, nor auricular neuro-acupuncture, nor flower boils, nor clay or oatmeal poultices, nor fruit smoothies or vegetables, or hop cushions …

None of them cure trigeminal neuralgia.
We recommend that you do not waste time and distrust them.

Talk to your doctors. Always.



References

    • Weigel G., Kenneth F, Casey M. Striking back! Gainsvillw: Trigeminal Neuralgia Association; 2000.
    • International Headache Society Classification Subcomitee. The international classification of headache disorders: 2nd edition, Cephalalgia. 2004; 24: 9-160.
    • Gronseth G, Gruccu G, Alksne J et al. Practice parameter: the diagnostic evaluation ans treatment of trigeminal neuralgia (an evidence based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology. 2008; 71: 1183-1190
    • Wiffen P, Collins S ,, McQuay H, et al. Anticonvulsant drug for acute and chronic pain. Cochrane Database Syst. Rev. 2000; CD001133
    • Janetta P. Trigeminal neuralgia: treatment by microvascular decompression. In: Wilkins R, Regachary S, eds. Neurosurgery. New York: Mc Graw-Hill; 1996: 3961-3968
    • Kanpolat Y, Savas A, et al. Percutaneous controlled radiofrequency trigeminal rhizotomy for the tratment of idiopatic trigeminal neuralgia: 25 year experience with 1600 patients. Neurosurgery. 2001; 48: 524-532



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