Trigeminal neuralgia - symptoms and treatment, diagnosis

December 21, 2020

Trigeminal neuralgia (facial or trigeminal neuralgia) is a disease of the peripheral nervous system characterized by short-term, intense and repeated pain in the area of innervation of one or more branches of the nerve. The nerve received its name due to the presence of three branches in it: ophthalmic (upper), maxillary (middle), mandibular (lower).

It is extremely difficult to independently diagnose pathology due to the nonspecific symptoms inherent in many diseases (for example, dental ones). That is why, if any unpleasant sensations occur in the facial area, it is necessary to promptly contact a neurologist. Trigeminal neuralgia most often affects adults, especially the elderly, and is more common in women.

The pathogenesis is not completely clear. It is currently believed that the disease occurs as a result of compression of the trigeminal nerve (at the site of its exit from the pons) by tortuous, pathologically altered vessels or, less commonly, by a tumor. As a result of compression, the nerve root adjacent to the cerebral pons undergoes demyelination. This reason explains up to 80-90% of cases of the disease. Rarely, patients with multiple sclerosis develop a plaque in the area of the sensory nucleus of the trigeminal nerve, which leads to neuralgia.

The factors that most often provoke the development of the disease include: pinching of the trigeminal nerve (temporomandibular joint injuries, congenital anomalies in the development of bone structures of the skull, tumors of the brain and facial area, pathological vasodilatation, etc.); viral nerve damage (herpetic infection, polio); odontogenic infections (“unsuccessful” filling or extraction of teeth or other surgical interventions in the face and oral cavity, reaction to anesthesia of dental canals, dental flux).

Trigeminal and facial neuralgia

Neuralgia is a disease in which damage or compression of the trigeminal nerve and/or its branches occurs. This causes a sharp piercing pain that occurs suddenly and brings physical and psychological discomfort to the patient. Despite the fact that the term “neuralgia” can be literally translated as “nerve pain,” the matter is not limited to pain. Trigeminal and facial neuralgia are radically different in symptoms. The facial nerve contains mostly motor fibers, so neuralgia leads to dysfunction of the facial muscles (the degree depends on the severity of the disease), and can also cause lacrimation, dry eyes and partial loss of taste. Pain in facial neuralgia is usually concentrated in the area of the parotid gland (the patient complains that the pain radiates to the ear), but there may be no pain at all. It is because of the lack of pain that some experts use the term “neuropathy” when talking about damage to the facial nerve. With the trigeminal nerve it’s exactly the opposite, since it contains many sensory fibers.

Diagnosis of neuralgia

Diagnosis of neuralgia in the CELT Clinic does not cause difficulties, since it has a number of pronounced signs. When talking about the clinical manifestations of the disease, patients try not to touch the affected side of the face and remain in a tense state because they expect a new attack.

Studies are carried out on the functions of the facial and trigeminal nerves, which begin with assessing the symmetry of the patient’s face. In addition, a number of tests are carried out to check taste and sensitivity.

For the most accurate diagnosis of pathological processes in the nerves of the face, an ultrasound scan of the nerves is performed.

Symptoms of neuralgia

Facial pain (prosopalgia). A characteristic sign of neuralgia. Sharp and sudden, reminiscent of an electric shock. Usually lasts from 5 to 15 seconds, is paroxysmal in nature and can occur at any time. During periods of remission, the number of attacks decreases. Most often, pain occurs in the area of the cheekbones and lower jaw (both right and left), and can be localized in almost all areas of the face.
Impaired sensitivity. A severe form of neuralgia can lead to partial or complete loss of sensitivity of the skin.
Nervous tic of the eyelid (nystagmus), spasms and twitching of facial muscles.
Loss of coordination and motor skills are rarer manifestations of severe forms of the disease.
Headaches, fever, chills and weakness are syndromes caused by viruses and infections.

Symptoms

The first attack of pain can be triggered by elementary things that no person can do without: laughter, smiling, articulation, brushing teeth, eating, frostbite on the face. Pain appears in one half of the face. At first, the painful attacks are short-lived. They end, just as they begin, abruptly. Over time, pain occurs more frequently and lasts longer. Often the pain begins to originate in the jaw and can be confused with toothache. Then the painful sensations move to the area of the cheek, ear, and forehead. There is lacrimation, paresis of the facial muscle, and the face becomes asymmetrical. After the attack, a period of remission occurs, which lasts several minutes. During remission there is no pain.

Causes

Unlike neuritis, neuralgia is not an inflammatory disease. Fever, fever, swelling and other symptoms of the inflammatory process are not associated with this disease. However, if the trigeminal nerve is damaged due to neuritis, pain sensations that fit the description of neuralgia may well occur. To avoid confusion and differentiate the two pathologies, it is necessary to consider their etiology.

The cause of neuritis (like any other inflammatory disease) is viruses and infections that cause gradual destruction of the membrane and nerve trunk, and classical neuralgia in the vast majority of cases occurs due to mechanical effects on the nerve. Today, experts identify dozens of factors that provoke the development of the disease.

Main causes of neuralgia

Head injuries leading to changes in the cranial structure and displacement of bones.
Benign and malignant tumors that, as they grow, compress the trigeminal nerve.
Various bite pathologies and other dental anomalies.
Pathologies of the structure and diseases of blood vessels located in close proximity to the nerve (atherosclerosis, aneurysm, vasodilatation, etc.).
Sinusitis and otitis in chronic form.
Trigeminal neuralgia after tooth extraction. Occurs during a traumatic or incorrectly performed extraction procedure.
Damage as a result of infection resulting from a number of diseases: periodontitis, periodontitis, stomatitis, herpes, syphilis.

Trigeminal neuralgia from hypothermia occurs rarely. However, this factor contributes to the development of the disease and complicates treatment. The same can be said about decreased immunity, metabolic disorders, neurosis, diabetes and other complicating factors.

Classification of the disease

Due to the occurrence

Primary (idiopathic) trigeminal neuralgia. A classic type of neuralgia, so to speak. Occurs due to compression of the trigeminal nerve.
Secondary trigeminal neuralgia is a consequence of other diseases and viruses.

By coverage

Unilateral (one branch of the trigeminal nerve is affected).
Bilateral (more than one branch is affected).

Neuralgia can affect the 1st, 2nd, 3rd branches of the trigeminal nerve. The first branch is responsible for the orbital zone, the second for the median zone (including the nose and upper lip), and the third for the lower jaw. Most often, damage to the third branch is diagnosed, so the pain affects the area of the lower jaw, and an attack often occurs during hygiene, eating or shaving.

Types of trigeminal neuralgia

There is an additional classification that can also be used in making a diagnosis.

Acute

Acute trigeminal neuralgia, accompanied by frequent and severe attacks.

Chronic

Chronic trigeminal neuralgia is a consequence of an untreated disease. The patient has been observed for a long time: remissions alternate with exacerbations.

Atypical

Atypical trigeminal neuralgia occurs against a background of stress and nervous exhaustion (psychosomatics).

Postherpetic

Postherpetic trigeminal neuralgia occurs after a history of herpes and its symptoms differ from the classic type. The pain is usually burning and may not go away for two to three hours.

Types of neuralgia

Neuralgia that develops as a result of viruses and other diseases is called secondary. Primary or idiopathic is a disease caused by compression of a nerve. According to localization, it can be unilateral or bilateral. With unilateral neuralgia, one branch of the nerve is affected, with bilateral neuralgia, several.

According to the nature of the disease, it can be acute or chronic. With acute neuralgia, the patient experiences frequent and severe pain. If the pathology is not treated, it goes into a chronic stage, when exacerbation is replaced by periods of remission.

Postherpetic neuralgia develops after herpes and differs from the classic nature of the pain, which may not go away for several hours. An atypical form of neuralgia is a psychosomatic disease, which can be triggered by stress, depression, and nervous exhaustion.

Methods for diagnosing neuralgia

The disease is diagnosed using different methods that make it possible to establish its cause:

visual examination and questioning of the patient;
radiography;
MRI of the head;
biochemical studies of blood and urine;
electromyography.

To clarify the diagnosis, the neurologist often turns to doctors of other specialties - otolaryngologist, ophthalmologist, orthodontist. This is done to exclude diseases for which the same symptoms are typical.

Drug treatment of neuralgia

Effective treatment is only possible with the use of a comprehensive drug regimen. Anticonvulsants are prescribed first. Antihistamines and local analgesics are sometimes added to them to relieve acute attacks of pain. The deficiency of gamma-aminobutyric acid will be compensated by phenibut and similar neotropic drugs. In case of exacerbation, antidepressants may be prescribed. If the disease is caused by a viral infection, the patient is prescribed non-steroidal antiviral and antibacterial drugs.

Other treatments

To eliminate pain, physiotherapeutic procedures are prescribed: acupuncture, magnetic therapy, ultraphonophoresis. A good addition to drug treatment is head and face massage. If conservative treatment methods do not bring the desired effect, the patient may be prescribed a minimally invasive operation - microsurgical decompression, radiosurgery or percutaneous destruction.

Trigeminal neuralgia is not only painful, but also causes problems with the patient’s communication abilities. Constantly expecting attacks of pain, a person isolates himself from others, withdraws into himself, becomes irritable and depressed. The prognosis for treatment is favorable. The chances of a full recovery increase when the patient consults a doctor at an early stage of the development of neuralgia, when the first symptoms appear.

Diagnosis of the disease

Modern medicine has in its arsenal many diagnostic techniques that make it possible to determine the type of neuralgia and the cause of its occurrence:

visual examination and questioning of the patient;
X-ray of the jaw;
MRI of the brain and blood vessels;
laboratory analysis of urine and blood;
electromyography.

Diagnosis is carried out by a neurologist, but additional examinations by other specialists are often required: dentist, ophthalmologist, otolaryngologist. Particular attention is paid to differential diagnosis, since neuralgia may resemble other diseases in its symptoms, in particular glaucoma, otitis media, ethmoiditis, Slader syndrome, etc.

Treatment of trigeminal neuralgia

Treatment and drugs

For successful treatment, complex drug therapy is used. First of all, these are anticonvulsants (carbamazepine, finlepsin or clonazepam), which are included in the mandatory rehabilitation program and relieve the main manifestations of neuralgia. The dosage and duration of treatment are determined strictly by the attending physician.

For additional effect, antihistamines and local pain relievers may be prescribed. To compensate for the lack of gamma-aminobutyric acid (a kind of mediator between the brain and the nervous system), baclofen, phenibut or gabapentin are prescribed. In the stage of exacerbation of neuralgia, specialists often prescribe antidepressants to eliminate psychological discomfort (the most common remedy is finlepsin). If the cause of the disease is a virus or infection, antiviral and antibacterial agents, as well as NSAIDs, are prescribed. During the recovery period, it is recommended to take B vitamins.

Physiotherapy

To eliminate pain, novocaine blockades and sodium hydroxybutyrate injections are actively used. The most popular and effective physiotherapeutic techniques: acupuncture, ultraphonophoresis, magnetic therapy, and low-frequency laser therapy. Massage for trigeminal neuralgia is also a good addition to general treatment and allows for better blood circulation.

Diagnosis and treatment

The main diagnostic methods include:

CT or MRI (magnetic resonance imaging), which can rule out other causes of pain and identify vascular compression of the trigeminal nerve root;
radiography of the paranasal sinuses to identify chronic inflammatory and other pathological processes;
consultation with a neurologist;
OPTG (orthopantomogram), to assess the width of the bone canals;
dentist consultation;
general blood analysis.

Treatment of neuralgia includes the following main methods:

medicinal;
surgical treatment.

Drug therapy is selected individually for each patient, depending on the severity of the pathology. Surgical treatment is recommended in the absence of clinical effect from drug therapy.