Neuralgia of the trigeminal nerve: symptoms and treatment

Neuralgia of the trigeminal nerve or painful tick Tissot is a common ailment of the peripheral nervous system, which is characterized by the onset of intense paroxysmal pain in the zone of passage of one of the branches of the trigeminal nerve. It is worth noting that the trigeminal nerve is a mixed nerve that «responds» to the innervation of the facial muscles, as well as to the innervation of the masticatory muscles.



This ailment is more often diagnosed in people of working age. In extremely rare cases, it can begin to progress in young children. It is remarkable that it is the trigeminal neuralgia that is the most unpleasant and difficult to treat ailment, among a wide range of neurological pathologies. The reasons for its progression are quite numerous, and the symptoms are extremely unpleasant. In some cases, it may be difficult to diagnose, as manifesting symptoms may indicate other diseases.

Etiology

There are quite a number of reasons that can trigger the progression of neuralgia of this nerve. All of them can be divided into exogenous and endogenous. This suggests that the causes that can give a «push» to the development of the disease can be located both in the human body and outside it.

The main causes of the progression of trigeminal neuralgia:


  • traumatization of the face and skull of various severity — a common cause of neuralgia progression
  • hypothermia
  • pathology of blood vessels localized in close proximity to the branches of the nerve. This group of causes includes atherosclerosis, vascular anomalies, aneurysms, etc.
  • metabolic disorder
  • Stem stroke
  • the presence of ailments in the body in a chronic stage
  • tumors of benign or malignant nature
  • Multiple sclerosis
  • presence of cystic-adhesive processes in the area of ​​passage of nerve branches. They can occur after previously transferred diseases of dental, ophthalmological and otorhinolaryngological profile.

The pathological process usually affects not the whole nerve, but a certain part of it. If it is not timely to conduct a competent diagnosis and adequate treatment, then the process will spread to the entire nerve.

Symptoms

The most common lesion is the right trigeminal nerve (in 70% of clinical cases). It is rare when a bilateral defeat is detected during the diagnosis. Trigeminal neuralgia is cyclical. This suggests that the periods of exacerbation of symptoms are replaced by periods of their fading. More often exacerbations are observed in the autumn-spring period, when the temperature decreases, the humidity level changes and so on.

Pain syndrome

The most characteristic symptom of neuralgia. The pain is intense, sharp and painful. There is an attack. Most patients during this attack completely freeze and do not move until the pain subsides. They note that it is similar to the passage of an electric charge through the body. Paroxysm can last several minutes. The most unpleasant thing is that such attacks are repeated up to 300 times in 24 hours, and greatly exhaust the patient.

Usually, pain is localized in the innervation zone of one of the branches of the nerve, but it can also be observed on the entire side of the face. A characteristic feature — pain from one branch can spread to another (irradiate). It is also worth noting that the longer a person develops ailment, the greater the likelihood that the pain will spread to half of the face.

To provoke the onset of pain syndrome can physically affect trigger regions. Usually, there is enough pressure to cause pain.

Trigger areas:


  1. corner of the mouth
  2. Eyebrow
  3. the back of the nose
  4. mucous cheeks;
  5. The wing of the nose.

Motor and reflex disorders


  • A characteristic symptom is the spasm of the muscular structures of the facial region. From this symptom the name of the ailment — «painful tick» has occurred. During the attack, the patient has an uncontrolled muscular contraction of the masticatory muscles, the circular muscles of the eye, and other muscle structures of the face. More often spasm is observed on all half of face from defeat,
  • changes in reflexes. To detect violation of the mandibular, superciliary and corneal reflexes is possible only on a neurological examination.

Vegetative-trophic symptoms

These symptoms occur during an attack. It is worth noting that in the early stages of development of pathology, they are weak. Their severity increases with the progression of neuralgia.


  1. the skin turns red or turns pale;
  2. lacrimation
  3. increased salivation
  4. runny nose
  5. Symptoms such as facial edema, loss of eyelashes and dry skin are noted in the late stages of pathology.

Symptoms of late stage neuralgia:


  • the pain ceases to be of a paroxysmal nature, but becomes permanent
  • pain immediately spreads to the entire half of the face
  • pain syndrome occurs even with loud sounds or light stimuli
  • it is noteworthy that paroxysm can provoke even a memory of it.

Diagnostics

If you have a painful syndrome, you should immediately go to a doctor for a comprehensive diagnosis. The doctor will need to collect an anamnesis of the disease and evaluate the symptoms. When performing a neurologic examination, the specialist has the opportunity to identify areas of sensitivity reduction on the skin of the face.




It is worth noting that during periods of remission of symptoms the doctor may not even reveal the presence of pathology. To establish the true cause of the progression of the disease in the diagnostic plan include an MRI.

Healing measures

Treatment of neuralgia is carried out by three methods:


  1. Medical;
  2. physiotherapy;
  3. operational.

Medication:


  • carbamazepine;
  • baclofen
  • gabapentin;
  • sodium hydroxybutyrate;
  • Trental
  • nicotinic acid;
  • B vitamins
  • glycine.

Physiotherapy treatment:


  1. diadynamic currents;
  2. Electrophoresis;
  3. laser therapy;
  4. Ultraphonophoresis

Physiotherapeutic methods of treatment are used in tandem with medicamental treatment. This makes it possible to achieve a qualitative and rapid effect.

If conservative treatment did not bring the expected effect and the patient’s condition did not stabilize, then the doctor decides to conduct surgical treatment.

Surgical procedures of treatment:


  • percutaneous balloon compression
  • microvascular decompression
  • glycerin injections
  • radiofrequency ablation;



  • use of ionizing radiation for the destruction of the affected nerve