Trigeminal Neuralgia: Symptoms, Causes and Treatment

Neuralgia of the trigeminal nerve is a serious pathology that causes severe facial pain. It is otherwise called neuritis. In turn, neuralgia is pain along the course of the trigeminal nerve. It can act as an independent impairment of sensitivity. Although often inflammation accompanies it. Dental problems, other neurological disorders, and hypothermia can cause this disease.

Doctors associate the development of the pathology with damage to the trigeminal nerve. Neurologists can suspect the disease by the following symptoms:

• intense burning pain on the right or left side of the face. It has an attack-like nature;
• impaired sensitivity of the skin.

Trigeminal neuralgia usually affects adults. In children and adolescents, the disease is sporadic. Faced with the trigeminal neuralgia triggers, the person cannot lead a normal life. Thus, they often become temporarily unable to work.

Self-diagnosis of the pathology is extremely difficult because of the nonspecific symptoms. Because they are inherent to many diseases (e.g., dental). Thus, if you feel face discomfort, you should immediately consult a neurologist. Read the following article for more information about what can cause trigeminal neuralgia. Also, we will tell you how to diagnose and treat it.

What is Trigeminal Neuralgia?

Trigeminal neuralgia is one of the most common facial pains. It is among the most persistent pain syndromes in clinical neurology. The trigeminal nerve is the largest of the 12 cranial nerves. It belongs to the mixed type of nerve and includes susceptible fibers.

The nerve gets its name from the presence of three branches in it:

• The oculomotor branch provides sensitivity to the forehead and eyes;
• The maxillary branch provides sensitivity to the:

• cheeks;
• upper jaw;
• upper lip;
• palate;

• The mandibular branch provides sensitivity to the lower jaw and lower lip. Also, it provides movement of the muscles involved in chewing and swallowing.

Everyone needs to know the early symptoms of trigeminal neuralgia. Trigeminal inflammation is a severe and chronic condition with remissions and exacerbations. Doctors describe it as having episodes of intense, shooting pain in the face.

Trigeminal neuralgia is more difficult to treat than other types of chronic pain. It also leads to temporary or permanent disability. This makes it a significant economic and social problem. Vascular, endocrine exchange, and immunological factors are in the pathogenetic mechanisms. 

The sensitivity of the nuclei changes because of them. You can also have the focus of pathological activity in the central nervous system. After that, trigeminal neuralgia triggers cause facial pain attacks. It occurs in the innervation of various nerve branches:

• The vascular factor takes part in classic neuralgia. At this point, a vertically crossed arterial loop affects the nerve root.
• Doctors especially focus on endocrine-exchange conflict (nerve-vessel conflict). It occurs in people whose arteries and nerve fibers begin to sclerose. It is the most common cause in the elderly with trigeminal neuralgia.
• Autoimmune processes cause inflammatory reactions with dental treatment and colds. In this case, it is what causes trigeminal neuralgia and pain.

Early Symptoms of Trigeminal Neuralgia

The main symptoms of trigeminal neuralgia are sharp, stabbing pain. They spread from the face to the side (temporal) of the head (right or left). The pain is very intense but, more often, short-lived. Pain with trigeminal neuralgia can occur in different parts of the face. It all depends on which nerve branch has pain:

• Maxillary. It usually occurs in the facial muscles, upper jaw, and nose.
• Mandibular. It is a pain that will resemble a toothache.
• Ocular. You can feel it in the temples, forehead, and above eyebrows.

Otherwise, trigeminal pain can be long-lasting for up to several days. Most often, the pain is localized on one side of the head. So it is easier to find trigeminal neuralgia triggers. Facial pain can occur spontaneously, or you can provoke it:

• facial expressions;
• brushing your teeth;
• touching certain areas of the face (trigger points).

Typical signs of pain syndrome in trigeminal neuralgia include:

• the character of facial pain – acute, short-term, intense;
• the duration of the attack – from 10 seconds to 2 minutes;
• localization of pain and its direction always remaining unchanged;
• involuntary convulsions of masticatory and facial muscles at the peak of pain sensations. 

Their frequency varies from single cases to dozens or even hundreds a day. The attacks become more frequent during exacerbations (more often in the cold season). So it is important to determine what can cause trigeminal neuralgia.

During the remission period, patients live in fear. They fear an exacerbation of the disease and cover their heads even in the summer. Patients fear not touching the diseased half of the face. They also do not brush their teeth or chew on the affected side. Several early symptoms of trigeminal neuralgia can state:

• facial muscle spasms;
• increased salivation;
• increased or decreased sensitivity of the facial skin;
• moderate increase in temperature;
• weakness and pain of the facial muscles.

Atypical trigeminal neuralgia is less common. It causes a less intense but constant dull burning or aching pain.

Trigeminal Neuralgia Triggers

The trigeminal nerve can suffer trauma:

• fractures;
• tissue tears;
• unprofessionally administered conduction anesthesia. 

It can also break due to the destruction of the myelin sheath of the nerve itself. It is a typical problem for patients with sclerosis. But more often, we talk about the pathology’s inflammatory nature.

The most common causes leading to damage to the trigeminal nerve are:

1. Compression of the trigeminal nerve as a whole or its branches in the background.

2. Viral lesions directly on the nerve: herpes, polio, AIDS.

3. Atherosclerosis. It is a disease involving impaired blood circulation in the blood vessels of the brain.

4. Abnormal location of cerebral vessels. So they can pinch the nerve and lead to damage to the trigeminal nerve.

5. Dental problems: 

• complications after root canal filling;
• specific reactions to the introduction of anesthetics;
• periostitis and other inflammatory diseases.

6. Multiple sclerosis. It is a complex pathology of nerve myelin sheath destruction.

7. Aneurysm. An aneurysm is an area of enlargement of one of the arteries in the cranial cavity. A dilated artery can pinch the trigeminal nerve, causing unpleasant symptoms.

8. Overcooling of tissues in the facial area. Hypothermia results in poor circulation with the stagnation of venous blood. There is also a slowing down of the metabolism in certain areas.

Risk Factors of Trigeminal Neuralgia

The risk of developing trigeminal neuralgia is greatly increased:

• over the age of 50;
• mental disorders;
• regular hypothermia;
• insufficient intake of nutrients and vitamins (anorexia, bulimia, malabsorption, etc.);
• regular overexertion, stress;
• worm infestations and other helminth infestations;
• acute infections: malaria, syphilis, botulism, etc.;
• chronic inflammation in the oral cavity (caries, gingivitis, abscesses, etc.);
• in the background of autoimmune lesions;
• in overexposure to allergies;
• metabolic disorders.

Trigeminal neuralgia is an independent disease. Compression of a nerve root by neighboring tissues can cause damage to the trigeminal nerve. It can also be a symptom indicating pathology in neighboring tissues and vessels. 

Over time, trigeminal inflammation symptoms can lead to neuropathic complications. They can also lead to developing a secondary pain syndrome in the head. Patients with nerve disease use only the healthy half of their mouth when chewing food. As they are afraid to cause trigeminal neuralgia triggers. It results in: 

• the formation of muscle thickening;
• loss of sensation in the affected half of the face.  

In the chronic form of the disease, the auditory and facial nerves have severe pain. Without treatment, trigeminal neuralgia can lead to more serious complications:

• dystrophy of the masseter muscles;
• decreased sensation in the affected area;
• contracture and spontaneous contraction of the facial muscles;
• conjunctivitis.

How Trigeminal Neuralgia Diagnosed?

It is possible to determine this disease by tomography, CT scan or angiography, and other methods. Only after the interview can the physician distinguish damage to the trigeminal nerve from:

• Schostad’s syndrome;
• postherpetic pain;
• typical migraine. 

Because in this syndrome, the attacks are more prolonged. But, to understand the full picture, it is important to make a comprehensive diagnosis:

Blood and urine tests are also prescribed in most cases of damage to the trigeminal nerve (especially the role of these tests is valuable in pathologies resulting from infectious diseases).

Treatment of Trigeminal Neuralgia 

Treatment is aimed at controlling the pain syndrome. Also, it can prevent the recurrence of the disease:

• in the milder course of the disease, medication can help;
• in advanced stages, extensive areas of surgical lesion treatment are used. It also helps to overcome the nature of the trigeminal neuralgia triggers.

In the non-acute phase, therapeutic baths, massages, acupuncture, and paraffin therapy are useful. Surgical operations are the most effective for fighting trigeminal neuralgia. They allow not only eliminate the pain but also cut the chain of impulsion to affect the conflict between the cranial nerve root coming out of the brain stem and the vessel that adjoins it. Medication therapy can often show good results in reducing early symptoms of trigeminal neuralgia. Doctors prescribe the following medications:

• Drugs to control symptoms. They relieve pain in 70-80% of patients with trigeminal neuralgia.
• Antispasmodics and myorelaxants of central action. They are some of the common drugs in this situation.
• Alcohol blockades are good at “freezing” the affected area of the face. The effect of the blockage is there, but it is short-lived. Therefore, such injections are most often used as a temporary measure.
• Anticonvulsants. They help slow down the process of transmission of nerve impulses.
• B vitamins. They have a neurotropic effect (they improve mediator metabolism and have some analgesic activity, so they increase the effect of painkillers).

Physiotherapy techniques are also used to treat damage to the trigeminal nerve. But most doctors are inclined to the fact that they are effective as auxiliaries. They enhance the effect of conservative medications. And doctors can also use them after surgery in the rehabilitation stage. For example, drug treatment at the acute stage is effective to combine with:

• light therapy, especially infrared ray therapy in small doses;
• phonophoresis;
• electrophoresis;
• darsonvalization. 

Consult the Best Neurologists from Lone Star

When early symptoms of trigeminal neuralgia appear, you should immediately see a neurologist. Because timely diagnosis is crucial in the treatment of neurological pathologies. Contact our Lone Star Neurology clinic for help. Because we have the best neurologists in our clinics.

FAQs 

• How do you get trigeminal neuralgia?

The most common triggers include trigeminal nerve impingement (trauma to the temporomandibular joint, congenital anomalies in the bone structures of the skull, tumors of the brain and facial area, abnormal vessel enlargements, etc.).

• Does trigeminal neuralgia cause swelling?

Yes, swelling is one of the accompanying symptoms. You can get rid of it by applying an anti-inflammatory ointment to the pain area. You can also make a warming compress.

• How common is trigeminal neuralgia?

The prevalence of trigeminal neuralgia (NTN) is relatively high, with up to 30 to 50 patients per 100,000 population, and the incidence, according to WHO, is between 2 and 4 per 100,000 population. NTN occurs more often in women aged 50-69 and has a right-sided localization.

• How do you calm down trigeminal neuralgia?

To relieve pain, you can use cognitive behavioral therapy, biofeedback, relaxation techniques, and medications such as anti-seizure drugs or tricyclic antidepressants. Your doctor can help you determine the best approach for your individual situation. Avoid drafts and being out in the cold.