Related articles: Inflammation of the trigeminal nerve
Definition
Trigeminal neuralgia is a neuropathic disorder characterized by intense facial pain .
The trigeminus is the 5th cranial nerve, which branches symmetrically both to the right and to the left in the head, innervating the face, the anterior part of the skull and the oral cavity.
The exact mechanism underlying trigeminal neuralgia is not yet clear. In most cases, there is a functional alteration of the nerve termination, due to local demyelination which involves the transmission of abnormal stimuli to the brain. This dysfunction can be determined by the contact between the trigeminal nerve and a blood vessel that runs close to it. Sometimes, it may depend on other conditions: tumors, plaques of multiple sclerosis, traumas, infections or other lesions that compress the 5th cranial nerve or interrupt its pathways in the brainstem. Trigeminal neuralgia mainly affects adults, particularly the elderly.
Most common symptoms and signs *
- Tinnitus
- Pain associated with chewing
- Facial pain
- Ocular pain
- Tingling in the head
- Fotofobia
- Otalgia
- Paresthesia
- Muscle spasms
Further indications
Trigeminal neuralgia manifests itself with excruciating pain, often described as an electric shock or lash. The pain is paroxysmal (violent and of short duration), localized in correspondence of one or more sensitive branches of the trigeminal nerve: forehead and eye, jaw up to the chin or upper part of the cheek.
Trigeminal neuralgia can occur without warning. A painful episode lasts from a few seconds to 1-2 minutes, but more attacks can recur in rapid succession. In the intervals between one crisis and another, a dull background pain may persist.
Often, an attack can be triggered by stimulation of specific areas of the face (zone triggers). Pain, for example, can be triggered by vibrations or contact with the cheek, such as those that arise during chewing, brushing the teeth, shaving or applying makeup.
In most cases, neuralgia affects only one side of the face (unilateral). Rarely, patients have bilateral pain.
Trigeminal neuralgia is diagnosed with medical history, physical examination and imaging techniques. The latter, in particular, are useful to exclude other causes that can lead to pain and loss of facial sensitivity (migraine, post-herpetic pain, tumor, aneurysm, multiple sclerosis, stroke, vascular malformations, etc.).
Trigeminal neuralgia is a chronic (long-term) disease. If left untreated, it often tends to worsen over time, with attacks followed by shorter periods of remission. Several treatments are available that can effectively relieve pain: therapy usually involves the use of anticonvulsant drugs (eg carbamazepine or gabapentin) or surgery. If neuralgia is secondary, instead, it is necessary to treat the underlying causes.
