Trigeminal neuralgia

Trigeminal neuralgia is pain produced in an area of ​​the face innervated by the trigeminal nerve (cranial nerve V). This branches into three branches and is the main sensory nerve of the head. It is also the nerve in charge of chewing.

Trigeminal neuralgia appears mainly after 50 years of age and has an approximate incidence of 4.3 inhabitants / year. It predominates in women.

How is it produced?

The causes are not well established, but it seems that it is caused by demyelination phenomena (loss of the cells that surround and protect the nerve) secondary to its compression in some section of its path.

Symptoms

It is characterized by very intense facial pain, in the form of sudden attacks that can last from one second to two minutes. It is an acute, stabbing or superficial pain that occurs spontaneously in the areas innervated by the trigeminal nerve, by stimulating a series of areas (trigger areas) by just touching them lightly or by triggers such as talking, washing the face, shaving, smiling, It is a pain that does not usually wake up the patient.

Idiopathic trigeminal neuralgia (without associated disease) usually presents remissions lasting months or years, but seizures often recur again and less frequently between them. If it appears in the bosom of another disease, the evolution will depend on it.

Diagnosis

It is a diagnosis based on symptoms and physical examination, especially to rule out other causes of facial pain such as dental pain, sinusitis, headache, etc.

In young people, with atypical facial pain and predominantly bilateral involvement, the study should be completed with neuroimaging tests such as brain CT, brain MRI and angiography among the most used.

Treatment

Treatment is mainly drug-based. The drug of first choice is carbamazepine. Others used are phenytoin, topiramate, pregabalin, and lamotrigine. These are anticonvulsant drugs, so the doses must be adjusted very well, starting with low doses and increasing them depending on the side effects. In general, these drugs are kept for 6-12 months and then they are gradually withdrawn. In cases of severe pain both in frequency and intensity, the treatment can be maintained for a longer time.

Surgical treatment is reserved for those cases that do not respond to medical treatment or when its side effects are very important. The goals of surgery are to decompress the nerve or destroy the nerve fibers that transmit pain perception.