Trigeminal neuralgia: when the face hurts

Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine 

Trigeminal neuralgia is manifested by pain that usually affects only one side of the face. It can be due to a compression of a nerve just as it can be the consequence of another disease. What exactly is trigeminal neuralgia? What are its causes and symptoms? How to diagnose it? How long does it last? How to treat it? The answers in the rest of the article.

Trigeminal neuralgia: definition and anatomy

 

La neuralgia indicates spontaneous or continuous pain localized in the course of a nerve. We are talking about trigeminal neuralgia because the nerve in question is the trigeminal nerve. It is about the fifth nerve forming part of the 12 pairs of cranial nerves responsible for the innervation of the face. As this neuralgia affects the sensory nerve of the face, it is also called " facial neuralgia ».

 

The orifice of this fifth nerve extends from the brainstem to the inside of the skull. Also called " trifacial nerve », it joins the trigeminal ganglion which is in the cavum of Meckel. From there, it splits into 3 branches to allow movement of the mandible and sensitivity to different parts of the face. And this, leaving the skull through bone orifices.

 

 

• The first branch concerns the ophthalmic division or the superior territory. It ensures the innervation of the forehead and the eyes.
• The second is the maxillary division or the superior maxillary territory. This takes care of the sensitivity of the cheek, the palate and the upper lip.
• As for the third branch, it is the mandibular division or the lower maxillary territory. It innervates the lower lip and the jaw. It also gives movement to the muscles that are involved in swallowing and chewing.

 

 

What causes trigeminal neuralgia?

 

Although common in women over the age of 50, facial neuralgia also affects middle-aged and older people. The same is true for those who suffer from multiple sclerosis. This chronic neurodegenerative disease promotes the deterioration of the protective sheath of the fifth nerve.

 

 

La trigeminal neuralgia is due to compression or trigeminal nerve irritation. In the majority of cases, the origin of this compression remains unknown. However, according to different hypotheses, it may be the result of:

 

• contact with a vein or artery, especially the cerebellar artery. In this case, the vein or the artery compresses the nerve and makes it unable to carry out its functions correctly;
• aging of the myelin sheath that protects the nerve;
• epilepsy;
• a malformation of neighboring vessels;
• another pathology related to the oral region or of tumoral, vascular, infectious (shingles), inflammatory type…

 

When facial neuralgia is linked to the presence of other diseases, it is said to be “secondary”. Otherwise, we speak of essential neuralgia.

 

It is important to emphasize that stress is not a risk factor for this type of neuralgia.

 

 

What are the symptoms of trigeminal neuralgia?

 

La trifacial nerve compression causes painful attacks similar to tics. Indeed, these crises are expressed by facial contractions or uncontrollable grimaces. Some patients even describe them as electric shocks because they are violent and occur unexpectedly.

 

 

Even if the pains are generally unilateral (affecting only one hemiface), in rare cases, it is possible that they are bilateral. When they appear, they mainly affect the cheeks, lips, jaw, gums, chin, and sometimes the forehead. They can be:

 

• spontaneous;
• caused by contact with a particular facial area called the “trigger zone” or “trigger zone”;
• caused by certain movements: chewing, blowing your nose, shaving, etc.;
• triggered by stress, cold or drafts.

 

If the manifestation of essential facial neuralgia occurs discontinuously, that of secondary neuralgia is continuous. In addition, the latter can cause permanent disorders of motor skills or facial sensitivity.

 

 

How to diagnose trigeminal neuralgia?

 

For most facial pain, patients consult either a general practitioner or a dentist. If necessary, they can refer them to a neurosurgeon or neurologist.

 

During the consultation, a clinical diagnosis is made. The practitioner bases himself on the description of the pain made by the patient. It's easy toidentify essential facial neuralgia through pain characteristics.

 

If you have a secondary facial neuralgia, medical examinations can be carried out to understand the causes. Among other things, for a suspected tumor, the specialist performs an MRI. While a blood test is necessary in case of the presence of signs indicating an infection. With regard to the hypothesis of a case of shingles, a microscopic analysis of the vesicles located at the level of the ears may prove necessary.

 

 

 

How long does trigeminal neuralgia last?

 

At first, the seizures are mild and brief. They only last for a few seconds. But during theevolution of neuralgia, the seizures become progressively intense, frequent and long-lasting. As for crisis periods, they can last for days, weeks, months, and even years.

 

It should be noted that no pain is felt between attacks. However, the remission time tends to become shorter and shorter as the neuralgia progresses.

 

 

How to relieve trigeminal neuralgia?

 

Le treatment of facial neuralgia to recommend in the first place is drug treatment. When this no longer has an effect or when the pain persists, techniques such as surgery, radiotherapy or thermocoagulation can be used.

 

 

As medication, the doctor often prescribes antiepileptics because of the ineffectiveness of analgesics such as paracetamol. He may also use anticonvulsants (such as carbamazepine), migraine medications (such as sumatriptan), or muscle relaxants (such as baclofen).

 

When drug treatment no longer manages to relieve the pain, surgery may be recommended. It consists of eliminating the troublesome vessel and protecting the nerve. The effect of this operation can last for several years.

 

Thermocoagulation is an alternative to this operation. She allows to destroy the small fibers of the trigeminal nerve with heat. It helps to soothe pain while maintaining the functions of the large fibers that ensure the sensitivity of the face.

 

An irradiation technique can also be used. This technique is recent and uses the Gamma Knife. It consists of having the patient wear a multi-beam helmet which will irradiate the trifacial nerve.

 

 

The unpredictability of trigeminal neuralgia attacks makes prevention almost impossible. Nevertheless, when a trigger zone is identified, it is possible to be careful not to touch it. This can be difficult when it reaches the level of the jaw because it must move to speak, drink or chew.

 

In order to relieve the pain, the best solution is to consult a specialist so that he can find an appropriate treatment. If left untreated, trigeminal neuralgia can become a real handicap in daily life.