What is Trigeminal Neuralgia?
The neuralgia of the trigeminal nerve, also known as tic douloureux, is a disorder of the trigeminal nerve leading sensitivity information to the brain from the face. Such a disorder causes severe pain in the areas through which the trigeminal nerve passes and can affect any age, but it is more common in the elderly.
This nerve gets its name because it has three branches:
- Ophthalmic Branch , in the region of the eyes and forehead;
- Maxillary branch , which accompanies the upper jaw;
- Mandibular branch , which accompanies the mandible or lower jaw.
The disease can also be referred to as trigeminal neuralgia, paroxysmal facial pain syndrome, Fothergill disease and painful prosopalgia.
This disorder causes episodes of sudden and severe pain on one side of the face, usually in the eyes, lips, nose, scalp, forehead and / or jaw. The pain is compared to a painful, intense and disabling shock, which can last for seconds, minutes or even hours, and can be triggered by routine actions. The pain can settle on a branch or be distributed according to the affected branch, this is due to the fact that the affected nerve is sensitive.
The annual incidence of the disease is about 4.3 people out of 100,000 in the general population.
The most common cause is when an artery compresses the trigeminal nerve inside the skull, which causes the pulse of that blood vessel to cause the nerve to become inflamed and thus cause pain. The neurologist Dr. Cláudio Fernandes Corrêa says that the pain can also be caused by dental treatment, but that this has still been proven.
Other causes that can also cause pain are:
- Increased blood pressure;
- Multiple sclerosis;
- Viral infection;
It must be kept in mind that there are other diseases that can cause pain in the face and that should not be confused with trigeminal neuralgia, such as toothache, sinusitis and pain caused by herpes.
Neuralgia pain is triggered by routine acts, some of the most common triggers are:
- Caress or lightly touch your own face;
- To chew;
- To brush your teeth;
- Apply makeup;
- To smile;
- Wash the face;
- Certain facial expressions or reflexes;
- More intense wind.
The most common is that trigeminal neuralgia manifests itself in older patients, since more than 60% of patients with the disease are over 60 years of age. It is also more common in women, with a ratio of 3 women to 2 men.
Despite being more common in the elderly, exceptions can occur and the disease can manifest at any age.
The pain may appear spontaneously, but it is usually triggered by touching a particular area or by routine actions, such as brushing your teeth. When it manifests, the most common symptoms are:
- Mild and occasional pain, like stitches;
- Severe pain, with sudden onset and that can be related to an electric shock;
- Crises lasting a few seconds;
- Episode with several attacks, which can last for days, weeks or months;
- Pains in the areas through which the trigeminal nerve passes;
- Pains on only one side of the face;
- Pains that stick in one place or radiate to other areas of the face;
- Crises increasingly frequent and intense.
The face may also be red in the affected area, as the nerve has a component related to vasodilation. The disease can affect both sides of the face, but never at the same time.
The most common areas to be affected are:
- Maxillary branch (55% of frequency);
- Mandibular branch (30% frequency);
- Maxillary and mandibular branch simultaneously (20% frequency);
- Ophthalmic and maxillary branch (10% frequency);
- Ophthalmic branch (4% frequency);
- All trigeminal branches (1% frequency).
According to the criteria established by the International Association for the Study of Pain (IASP) and the International Classification of Headache Disorder (ICHD), the diagnosis must be exclusively clinical.
If you experience severe and persistent pain in your face, seek out one of these specialists: neurologist, ophthalmologist, rheumatologist, dentist or otorhinolaryngologist.
The doctor will be able to diagnose you through the descriptions made of the pain, following the following criteria:
- Type : description of the pain if it was sudden -, the duration of the pain and the intensity of the pain;
- Location : through the affected areas of the face, the doctor will be able to confirm whether it is the disease;
- Triggers : pain is usually triggered by everyday actions, therefore, these factors also collaborate to confirm the diagnosis.
The specialist may also perform some tests to help diagnose and determine the cause of the disease. Some of these exams are:
- Neurological examination : the patient’s face is examined, so that it is then able to determine exactly where the pain occurs and which branches of the trigeminal nerve were affected;
- Magnetic resonance imaging : helps determine if trigeminal neuralgia is caused by a more serious problem, such as multiple sclerosis or a tumor.
To facilitate the diagnosis, you can make a list of all the symptoms and how long they have appeared, in addition to taking a medical history that includes other conditions that the patient has and the medications he takes regularly.
It is important to make sure that the pain is not attributed to other disorders and that no neurological disorder has been detected. Some disorders that can also cause pain in the face are:
- Giant cell arthritis;
- Tumor intracraniano;
- Multiple sclerosis;
- Otitis media;
- Hemicrania paroxística;
- Post-herpetic neuralgia;
- Temporomandibular joint syndrome;
- Other trigeminal neuropathies.
The most used treatment is medication, based on anticonvulsants (drugs that stabilize the membranes of the nerves) or narcotics. However, this type of treatment does not cure the disease, it only treats the symptoms.
If the drug treatment does not work, or the individual does not support the side effects, there are surgeries that can effectively cure the patient. The surgical procedure helps to eliminate nerve compression, moving the blood vessel apart and isolating it.
The drugs most often used for treatment are:
- Anticonvulsants : they are the most common and effective drugs in the treatment of trigeminal neuralgia. Usually, your doctor will recommend carbamazepine , but there are also other anticonvulsants that can be used in the treatment, such as oxcarbazepine and lamotrigine . If your medication stops working, your doctor may prescribe another medication or increase your dosage. Anticonvulsants can cause dizziness, confusion, drowsiness and nausea as side effects;
- Antispasmodic agents : drugs such as muscle relaxants can be used alone or in conjunction with the anticonvulsant. Side effects can include confusion, nausea and drowsiness;
- Botox injections : Some studies show that botox can reduce the pain of neuralgia in people in whom the drugs are no longer effective.
Read more: What is it and what is muscle relaxant for?
Some available surgeries are:
- Vascular microdescompression : the neurosurgeon, using a surgical microscope, removes the artery that is compressing the nerve and places an insulating material between them. The insulation is not absorbable and remains in place indefinitely. The procedure provides immediate relief and causes little or no numbness in the face;
- Sensitive rhizotomy : this procedure cuts the nerve, so that there is no more passage of pain signals to the brain, and causes anesthesia and permanent numbness in the face. The motor fiber of the trigeminal nerve is maintained, in order not to compromise the muscles of mastication;
- Needle procedures : a needle is inserted into the skin of the cheek until it reaches the region of the trigeminal nerve at the base of the skull. Thus, a medication is injected to prevent the passage of nerve impulses that take the sensation of pain to the brain;
- Alcoholization : this procedure consists of injecting alcohol into the trigeminal nerve to temporarily block its function;
- Balloon compression : performed under general anesthesia, the surgeon places a balloon, through a catheter, next to the trigeminal nerve, which is inflated and compresses the nerve, injuring the fibers that cause pain. After a few minutes, the balloon and catheter are removed. This procedure provides immediate relief, but it can cause mild numbness, chewing problems or double vision, and is usually effective for two years.
Open surgeries are more efficient and preserve the sensitivity of the face, but are not indicated for people over 70 years of age, due to the risks of the operation.
There are also radiation treatments, which are intended to act on the nerve root, preventing pain signals from reaching the brain. An example of such treatment is stereotactic radiosurgery , a non-invasive procedure that uses radiation beams to destroy parts of the trigeminal nerve. The injury caused by the procedure gradually develops and, consequently, complete pain relief occurs progressively.
While the treatment does not yet have complete relief, the patient continues to take his medication to control the pain. The treatment is not definitive, it has a 60% chance of effectiveness, it can cause numbness in the face and dry eyes, and the results, positive or negative, take up to a month to appear.
Although there are no studies on these treatment methods, some people report improvements with them. Some of these alternative treatments include:
- Vitamin therapy;
- Nutritional therapy;
Before starting any alternative treatment, consult your doctor, as alternative treatment can complicate your common treatment.
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Because trigeminal neuralgia is triggered by simple everyday acts, many patients even avoid getting out of bed in order not to activate the pain. This affects the quality of life and the patient’s emotional. The individual, then, should seek medical help to receive the best indications for their condition.
Some patients think and some even commit suicide to eliminate severe pain.
It is important to emphasize that the patient must strictly follow all medical guidelines and correctly obey the treatment.
As the disorder mainly affects elderly people, it is sometimes necessary to increase the dosage of the treatment, and some side effects may arise. Very high doses of medications can cause imbalance, dizziness and decreased ability to reason.
Another complication is related to the fact that not all patients can take the drugs prescribed for this disorder, just as some patients also cannot tolerate the effects of the medication.
There are also no known ways on how to prevent trigeminal neuralgia, a very negative point for patients.
Trigeminal neuralgia mainly affects elderly people, there is no way to prevent it and its symptoms can be activated through everyday actions. Share this article with your friends and family so they can find out how to treat the disorder!