Il pain caused by the trigeminal neuralgia It has many unpleasant characteristics: it is a chronic and sometimes unpredictable sensation, often stabbing and in some cases even burning. Furthermore, it involves the face, sometimes even both sides. This pain is due to theinflammation of the trigeminal nerve.
What is the trigeminal nerve?
Fifth cranial nerve, the trigeminal nerve It has the role of transmitting information received through the face to the brain. As its name suggests, three other nerves radiate from the trigeminal nerve, joined in the Gasserian ganglion:
- il ophthalmic nerve (V1), which reaches the eye, forehead and nose
- il maxillary nerve (V2), which extends from the side of the nose to the cranial meninges, the area under the eye and the upper dental arch
- il mandibular nerve (V3), which expands up to the jaw and “touches” the roots of the teeth
Another peculiarity of the trigeminal nerve, which explains the impact it can have on the quality of life in case of inflammation, is its "double identity": it is equipped with both a root, psychic (the largest), which allows it to affect the sensitivity of the head and face, which of a motor root, which particularly affects the muscles responsible for chewing.
Trigeminal Neuralgia: Classification and Possible Causes
You can understand what type of trigeminal neuralgia the patient is suffering from by observing his painful symptoms e determining the causes.
- Type 1 (TN1) or trigeminal neuralgia typical, characterized by intermittent, sharp pain that is not easily predictable, which occurs especially during the day and increases in intensity over time. In some cases, the specific cause of its development is unknown (neuralgia idiopathic)
- Type 2 (TN2), or trigeminal neuralgia atypical, which manifests itself with constant pain and sometimes accompanied by a burning sensation
- Type 3 (STN): neuralgia symptomatic it is secondary to another pathology
In the case of TN1, often an artery or vein is in the wrong position and causes compression of the trigeminal nerveAlthough trigeminal neuralgia can affect people of various ages (one in 25.000 suffers from it), it usually occurs mainly in women and in people in general over 50 years old.
TN2 neuralgia and TN3 neuralgia can instead be caused by a severe stress over a long period of time, anxiety or depression which contribute to muscle tension, multiple sclerosis, Herpes Zoster (if the virus has reactivated within a branch of the trigeminal nerve), exposure to coldMore rarely, compression of the trigeminal nerve can be caused by the presence of a tumor mass, from a malformation in the connection between veins and arteries or from a aneurysm.
Symptoms and diagnosis of trigeminal neuralgia
Since no initial symptoms of this disease can be identified, other than possibly some form of numbness or tingling in the face, it is not easy to prevent its development. As mentioned, it is pain, associated with an electric discharge, the main symptom of trigeminal neuralgia. A pain that is also rather ambiguous, as it may not appear again for a long time and then resurface again.
Although it can occur without any apparent stimuli, it is more common to feel pain after the so-called trigger point or trigger zone: It is specific points on the face, lips or tongueSince these areas are constantly in use in various daily activities, this can happen at any time, even while chewing or consuming very cold or very hot drinks.
These can be short, repetitive pains (up to a hundred a day), especially on the cheek near the nose or jaw. These pains can last from a few seconds to about two minutes, and their continuous recurrence can highly affect the quality of life, to the point of promoting long-term depressive states.
This consequence is more likely to materialize if the trigeminal neuralgia presents other symptoms:
- eye and/or ear pain on the same side of the face
- pain when chewing
- tinnitus
- light intolerance
- paraesthesia (altered sensation in the limbs)
- muscle spasms
Since the symptoms cannot be recognized through instrumental tests, it is necessary to meticulously analyze the pain caused by trigeminal neuralgia to exclude the presence of other pathologies. magnetic resonance It will then be essential to visualize any contact between the trigeminal nerve and a blood vessel or tumor mass.
Treatment for trigeminal neuralgia
In most cases (about 70% of patients), the treatment for trigeminal neuralgia is pharmacological. With the advice of a specialist, you can take: anticonvulsant drugs (which have a stabilizing action on nerve membranes), muscle relaxants (which act on the muscles) and antidepressants (both for the neuralgia itself and to respond to any depression that may arise later). To stem the inflammation, you can also opt for a cortisone therapy.
If drugs are not enough to relieve the pain or cause side effects in the patient, surgery is advisable. microvascular decompression (Janetta's procedure), particularly suitable for those who suffer from typical trigeminal neuralgia.
When this type of operation is impossible, for example if the patient is elderly or suffers from other pathologies that make general anesthesia risky, it is possible to proceed with percutaneous interventions of a destructive nature, which have as their objective the injury or interruption of a part of the nerve.
If, however, the trigeminal neuralgia originates in other pathologies, it is naturally necessary to establish a specific therapeutic pathIf a tumor mass is compressing the nerve, it will be necessary to remove the tumor itself. If the pain is caused by trigeminal herpes zoster, antiviral and painkiller medications should be started promptly.
