Trigeminal neuralgia: symptoms, causes, diagnosis and treatment.

This medical condition produces severe pain in one part of the face, near the eye or cheek.

There are few pains that cause as much disability and discomfort as ear-related pains or toothaches. Fortunately for the sufferer, these are temporary and can be easily remedied.

However, let us imagine that these pains appear fortuitously and chronically and that, in addition, treatments could not make the pain subside permanently. This is what happens in trigeminal neuralgia, a very painful disorder, which we will discuss below. which will be discussed below.

What is trigeminal neuralgia?

The condition known as trigeminal neuralgia is a chronic and painful condition 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 and stabbing pain that can last up to two minutes (Type II). Hence, this disease is also known as painful tic.

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

To understand this condition, it is necessary to know that this trigeminal nerve is one of the twelve pairs of cranial nerves that start at 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 upper branch carries sensations to almost the entire scalp, forehead and frontal area of the head.
• The maxillary or middle branch crosses the cheek, the upper jaw, the upper lip, the teeth, the gums and the sides of the nose.
• The mandibular or inferior branch which 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.

What symptoms does it present?

As previously mentioned, the symptomatology associated with trigeminal neuralgia is distinguished by the fact that it causes the patient a sharp, lacerating pain or suffering, similar to an electric shock that is usually felt on one side of the jaw or in the cheek. is usually felt in a side of the jaw or in the cheek..

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

• Contractions that cause very intense pain.The complete symptomatology of trigeminal nerve neuralgia may include: Contractions that cause a very intense pain, like an electric shock, lasting up to two minutes and that may occur constantly.
• Usually the pain only appears on one side of the face appears on only one side of the face. Specifically in the eye, the cheekbone and the lower area of the face.
• When the pain appears, there is no subsequent numbness and the pain can be felt for up to two minutes. Nor is the ability to move the affected area of the face lost..

In most cases patients can foresee the onset of the episode since it tends to be preceded by tingling sensations, stiffness or a mild but continuous sensation of pain.

One of the main characteristics of this symptomatology is that it appears suddenly and randomly. However, these incidents can be triggered by 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 pose a health risk to the person per se, the pain it causes can become highly disabling, causing the person to reject everything he or she can think of. the person refuses by all means to carry out those daily tasks that can cause a new crisis..

What causes this type of neuralgia?

Although in many cases the cause of trigeminal neuralgia remains undetermined, There are a number of situations and diseases that lead to the onset of these characteristic episodes of pain. of pain so characteristic.

The contexts in which it can appear are:

• Compression of the trigeminal nerve Compression of the trigeminal nerve by a Blood vessel: this compression may be caused either by the normal aging process itself or by the presence of a tumor.
• Multiple sclerosis (MS) or other diseases that cause myelin damage.
• Trigeminal nerve injury due to trauma or oral or sinus surgery.

How is it diagnosed?

At present, 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:

• Exploration of the person's medical history. of the person.
• Description of symptoms.
• Physical examination.
• Exhaustive neurological examination..
• Performance of 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 trigeminal neuralgia. treatments or interventions that can significantly improve the patient's situation.. These treatments are pharmacological therapy, surgery and other treatments or remedies.

1. Pharmacological therapy

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

• Anticonvulsant medication.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 using low doses of antidepressants low doses of antidepressants such as nortriptyline.
• Morphine derivatives such as dolantine.
• Botox injections in the nerve.

2. Surgery

A second option is the solution through certain types of surgery. However, the efficacy of their results is widely discussed by the medical community.

The main practice performed for trigeminal neuralgia is microvascular decompression (MVD), whereby the surgeon places an element between the nerve and the pressing blood vessel.

Other strategies involve undoing or severing 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 may also benefit from the effects of alternative treatments such as acupuncture or chiropractic combined with medication, because of the suggestion. Likewise, the use of capsaicin creams, modification of eating habits or cyanocobalamin supplements may also be helpful in reducing the intensity of symptoms.