Trigeminal Neuralgia: Characteristics And Treatment

Trigeminal neuralgia is for many the most painful condition that human beings can suffer, to the point of sometimes being the direct cause of some suicides. The origin is in a disorder of a cerebral nerve that reacts by producing violent electrical discharges to the simplest stimuli: talking, eating, a change in temperature …

It is not a simple headache, not even a migraine. Because those who are unlucky enough to have to live with trigeminal neuralgia know that painkillers are useless and in many cases not even morphine produces relief. In these cases,  only anticonvulsants allow one to lead a more or less functional life ; having to bear in return, yes, the side effects associated with this type of medication.

It is possible that from the outside this pain may seem exaggerated. However, if it is considered “the suicidal illness” it is not by chance. First classified in 1672, there are records of this disorder long before, describing it as one of the most disabling and intense pain that a person can suffer. At present, it is estimated that trigeminal neuralgia affects between 8 and 12% of the population, and although it is a chronic disease, there are treatments for it.

Trigeminal neuralgia presents with violent pain similar to an electric shock that can last from a few seconds to about two hours, repeating in several episodes over several consecutive weeks and even months.

What is trigeminal neuralgia?

Trigeminal neuralgia originates from the fifth of the twelve cranial nerves / nerves.  Now, it should be noted that this nerve has the peculiarity of being the longest of all those that are distributed in our head. Let’s see how it spreads to understand a little better how pain radiates:

  • This nerve has three branches, the first is the ophthalmic or superior, which radiates a painful sensation that can go from the scalp through one side of the forehead and the eye to that particular part.
  • The upper or middle branch stimulates the cheek, upper jaw, upper lip, teeth, and gums at the top of the mouth, as well as one side of the nose.
  • Finally we have the mandibular or lower branch, which produces the physical sensations of the lower jaw, the teeth and the gums of this part as well as the lower lip.

On average, patients with trigeminal neuralgia often experience pain on one side of the face. However, there is a rare condition known as bilateral neuralgia where indeed, there are people suffering from this condition on both sides of the head.

What are the symptoms of trigeminal neuralgia?

Symptoms associated with trigeminal neuralgia can vary between patients. However, there are what are known as “trigger zones”, areas that when stimulated respond with intense pain, such as an intense electrical discharge that can last seconds, minutes and up to two hours.

  • Simple actions such as touching the face or a caress can trigger a pain in the face.
  • Changes in temperature, the act of chewing, speaking or suffering from bruxism are situations that trigger the physical and disabling sensation of neuralgia.
  • The pain follows a path that can go from the scalp, through the eye, the ear to the jaw.
  • After that intense and deep electric shock, the person is often disabled for an hour or two. That is, during that time they will not be able to eat, drink or even open their eyes, until a certain time has passed where that nerve is gradually deflated.

Causes of trigeminal neuralgia

Trigeminal neuralgia does not have a single cause, in fact, this condition is associated with a wide variety of conditions. Let’s look at some of them to understand a little better the complex reality behind this condition.

  • It usually has a genetic origin.
  • Often times, and as can be seen by MRI, there is a blood vessel pressing on the trigeminal nerve as it exits the brainstem. This compression causes wear on the myelin, that layer that protects the nerve, hence such intense electrical discharges can occur.
  • On the other hand, it is known that injuries caused by traumatic accidents or even facial or oral surgeries can translate into neuropathic facial pain.
  • Likewise, it is important to note that a good number of patients suffer from trigeminal neuralgia of primary origin, that is, they are cases where it is almost impossible to know the origin that determines the disease.

What treatments are there?

One fact that we must bear in mind about this neuropathic condition is that not all cases are the same. There are people who suffer from this pain picture for two months in a row and then disappear for another period of time. There are those who suffer it on a daily basis, those who suffer from neuralgia on both sides of the face and those who have managed to control the triggers to enjoy a better quality of life.

Therefore, the therapeutic approach will be different for each person. Let’s see however which strategies are usually the most common.

  • Anti-seizure medications are often the most effective for treating trigeminal neuralgia. Drugs, such as carbamazepine, oxcarbazepine, or gabapentin, are usually the most common.
  • Likewise, it should be noted that tricyclic antidepressants such as amitriptyline or nortriptyline are also usually administered in these cases to reduce pain.

When the drug approach doesn’t work, the only option left is surgery. In these cases, you can choose to practice the following interventions:

  • Rhizotomy:  canceling or temporarily damaging certain nerve fibers so that they do not cause pain.
  • Glycerol Injection –  An outpatient procedure where the fibers surrounding the trigeminal nerve are abrogated. It is a treatment that lasts for at least two years.
  • Radiofrequency thermal injury: also an outpatient intervention where an electrode injures the nerve fibers that cause pain. It is also temporary.
  • Microvascular decompression, the most invasive (and effective) of all surgeries. A small opening is made through the mastoid bone behind the ear, to later remove that blood vessel that compresses the trigeminal nerve by means of a “balloon”.

To conclude, as we see, there are various approaches to be able to solve this chronic condition that affects between 8 and 12% of the population. However, it is also known that between 70 and 80% of patients respond well to drugs without having to undergo any surgical intervention. It would only be a matter of taking into account the personal characteristics of each patient in order to improve their social and personal life.

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