Neuralgia. Causes, symptoms and treatment of neuralgia
Trigeminal neuralgia is a chronic inflammatory disease of the trigeminal nerve (the largest sensory nerve of the face), characterized by paroxysmal pain syndrome.
This disease is also called facial or trigeminal(from Latin trigeminus or trigeminal) neuralgia.
Some statistics!
Trigeminal neuralgia occurs in 40-50 cases per 100 thousand population, about 5 people per 100 thousand population fall ill annually.According to statistics, women over 50 years of age are more often affected. Young people are less likely to get sick; a few cases of the disease have been described in preschool children.
Some interesting facts!
- The first descriptions of trigeminal neuralgia are found in ancient sources. Thus, the Chinese healer Hua Tuo was the first to use acupuncture for this disease, but this procedure did not cure, but only temporarily eliminated the pain syndrome. Hua Tuo was executed by the ruler of the Chinese Empire, who suffered from this disease, because the doctor was not with him during the onset of an attack of facial pain. This pain was so unbearable for the commander.
- Trigeminal neuralgia refers to idiopathic diseases, that is, diseases with an unknown cause. There is a lot of controversy among scientists about what leads to this disease, but a consensus has not yet been found.
- Manifestations of trigeminal neuralgia can resemble toothache, so dentists are often the first to see this condition. In this case, patients indicate pain in a completely healthy tooth; such a tooth may be mistakenly removed.
- Stressful situations and surgical interventions on the face and oral cavity contribute to temporary (up to several months) subsidence of pain syndrome in trigeminal neuralgia.
- Conventional non-narcotic analgesics are not effective in the treatment of neuralgia, they can only temporarily reduce pain, and with each dose they help less and less.
- Frequent attacks of unbearable pain due to trigeminal neuralgia can disrupt the patient’s mental state, leading him to depression, fear, aggressive states, and psychosis.
- An attack of pain with trigeminal neuralgia can be caused by even a light touch, for example, applying cream to the face.
How do nerves work?
Nervous system- one of the most important and complex systems of the body, which regulates, controls and carries out all processes occurring in the human body. We cannot do anything: neither move, nor think, nor show emotions, nor breathe, nor resist foreign agents, and we are not even able to reproduce without the participation of the nervous system.The human nervous system, especially the brain, has not yet been fully studied and is a treasure trove for new discoveries and Nobel Prizes. After all, it is almost impossible to predict a person’s reaction to various stimuli at one time or another, to even fully imagine a person’s capabilities, to understand the compensatory and restorative capabilities of the brain after injuries, infections and other pathological conditions of the nervous system.
And the most important human function, carried out by the nervous system - intelligence, distinguishes and exalts us above other creatures of planet Earth. Above creation artificial intelligence a huge number of scientists are working, but this moment This is not possible, the human nervous system is thought out by nature to the smallest detail and is unique.
Structure of the nervous system
central nervous system
The central nervous system in humans is represented by brain and spinal cord.Main functions of the central nervous system:
- regulates the functioning of all organs and systems, coordinates their joint synchronous work,
- ensures an adequate response of the body to various factors of the world around us,
- the implementation of mental functions, reason, thinking, emotions and so on, which distinguishes us humans from other creatures.
- bark brain,
- cerebral hemispheres brain (telencephalon),
- diencephalon: thalamus, hypothalamus, epithalamus, pituitary gland,
- midbrain: roof of the midbrain, cerebral peduncles, aqueduct of the midbrain,
- hindbrain: pons, cerebellum, medulla oblongata.
Rice. Schematic representation of the main structures of the brain.
Peripheral nervous system
Peripheral nerves include cranial and spinal nerves.Main functions of the peripheral nervous system:
- collection of information from the environment, as well as about the internal state of human systems and organs,
- transmission of impulses with information to the central nervous system,
- coordination of the work of internal organs,
- making movements,
- regulation of the functions of the circulatory system and others.
- Somatic nervous system– carries out movements and collects information from outside and inside.
- Autonomic nervous system:
- sympathetic nervous system - activates at times of stress, danger, reaction to environmental and internal environmental factors;
- parasympathetic nervous system – activates during rest, rest and sleep;
- enteric nervous system – responsible for the functioning of all parts of the gastrointestinal tract.
According to their functions, cranial nerves can be divided into:
- sensory nerves– are responsible for the perception and transmission of nerve impulses to the brain by the senses (hearing, vision, smell, taste, sensitivity of the skin and mucous membranes);
- motor nerves– responsible for muscle function;
- mixed nerves– nerves that have sensory and motor functions.
*Cranial nerve nuclei- these are formations of the nervous system that receive and transmit nerve impulses to the peripheral nervous system, namely the cranial nerves.
Nerves under a microscope
Neuron (nerve cell or neurocyte)- is structural unit nervous system, these cells are highly specialized, capable of reproducing and transmitting nerve impulses, which in their characteristics are very similar to electrical ones.Neurons vary in size depending on function and type, on average from 10 to 30 μm (minimum 3, maximum 120 μm).
“Nerve cells do not recover!” - truth or myth?
How many times have each of us heard this expression from doctors, teachers, parents. But in 1999, American scientists partially debunked this myth. Elizabeth Gould and Charles Gross proved that the central nervous system produces thousands of new neurons every day throughout life, they suggest that due to these new cells, a person’s memory improves, new skills and knowledge emerge. That is, these are sheets of white paper on which each person writes down something new for himself. Research is still being carried out in this direction; no one knows where it will lead the scientific world, but most likely these studies will change our understanding of the functioning of the nervous system. And, perhaps, new discoveries will help find effective treatments for diseases that are currently considered irreversible, such as multiple sclerosis, Parkinson's disease, Alzheimer's syndrome and others.Structure of neurons
What does a neuron consist of?- Dendritic processes– receive impulses from other cells, usually have a branched shape (like a tree, each branch is divided into branches). A neuron usually contains a large number of dendrites, but in some cells this process can be single (for example, retinal neurons that transmit impulses to the photoreceptors of the eye).
- Neuron body (soma) with the nucleus and other organelles. The body of the neuron is covered by two layers of fat (lipid membrane), a protein layer and an accumulation of polysaccharides (carbohydrates). Thanks to this structure of the cell membrane, the body of the neuron is capable of processing nerve impulses, and impulse accumulation occurs in it.
Soma also provides nutrition to the cell and removes waste products from it. - Axon hillock- a section of the neuron body from which the neuron axon extends; the function of this structure is to regulate the transmission of a nerve impulse to the axon, that is, excitation of the axon.
- Axon process- a long process through which information is transmitted to other neurons. Each neuron has one axon; the longer it is, the faster the nerve impulse is transmitted. The terminal sections of the axons are divided into terminal branches; they are the ones that connect to other nerve cells. An axon may be covered with or without a myelin sheath.
- Myelin sheath is an insulator of electricity; it is a membrane consisting of lipids and proteins. It consists of glial cells (Schwann cells in the peripheral nervous system and oligodendrocytes in the central nervous system), spirally enveloping the axon. Between the glial cells there are gaps - the interceptions of Rwanje, which are not covered with myelin. Thanks to myelin, electrical impulses are transmitted quickly along the nerves.
Types of neurons, depending on the functions performed:
- motor neurons – transmit impulses from the central nervous system to the peripheral nerves of the muscles,
- sensory neurons - convert impulses from the surrounding or internal environment and transmit them to the central nervous system,
- interneurons – neurons that transmit impulses from one neuron to another, mainly interneurons are represented by nerve cells of the central nervous system.
Nerve fibers– axons of neurons.
Nerves– accumulation (bundles) of nerve fibers.
Neuron connections
Neurons connect with each other to form synapses. Through them, one nerve cell (transmitting) transmits a nerve impulse to another nerve cell (receiving). A synapse can also connect a nerve cell with cells of innervated tissue (muscle, gland, organ).
The brain and spinal cord are a vast collection of interconnected neurons that have an extremely complex relationship.
Components of a synapse:
- Transmitting neuron axon(its presynaptic ending) is capable of stimulating the production of special chemical transmitters - transmitters. Mediators of the nervous system (neurotransmitters, neurotransmitters) are produced in synaptic vesicles of the presynaptic terminal.
- Synaptic cleft, an impulse is transmitted through it.
- Receptive part of the cell– or receptors on any receptive cell. Receptors can be located in the dendrite, axon or body of a neuron, on the membrane of sensitive cells of muscles, internal organs, sensory organs, glands, and so on.
Groups of neurotransmitters (neurotransmitters):- Monoamines: histamine, serotonin;
- Amino acids: Gamma-aminobutyric acid (GABA), glycine, glutamic and aspartic acids;
- Catecholamines: adrenaline, norepinephrine, dopamine;
- Other neurotransmitters: acetylcholine, taurine, ATP, etc.
How is a nerve impulse transmitted?
Nerve impulse– this is natural electricity that passes through electrical wires (nerves) in different directions and along certain trajectories. This electricity (impulse) is of chemical origin, carried out with the help of nervous system mediators and ions (primarily sodium and potassium).Stages of formation and transmission of nerve impulses:
- Excitation of a neuron.
- Turning on the sodium-potassium pump, that is, sodium moves into the excited cell through special sodium channels, and potassium moves out of the cell through potassium channels.
- Formation of a potential difference between the synapse membranes (depolarization).
- Formation of a nerve impulse - action potential.
- Transmission of nerve impulses along nerve fibers through synapses:
- secretion of neurotransmitters in synaptic vesicles of the transmitting terminal,
- release of mediators (or substances that destroy them - in the process of inhibition) into the synaptic cleft,
- stimulation of depolarization of the receiving cell (opening of sodium and potassium channels) - during excitation of the nerve fiber, or hyperpolarization (closing of sodium-potassium channels) during inhibition ** ,
- transmission of the impulse further along the nerve fibers to the central nervous system or innervated organ.
The speed of transmission of nerve impulses along nerve fibers covered with myelin is 2-120 m/s.
In addition to the transmission of nerve current through synapses, it is possible to directly propagate an impulse by contact, without the participation of mediators, with a dense arrangement of nerve cells.
Interesting! You can watch the video: “The incredible is all around us. Nervous system".
Reflex– this is the body’s reaction to any irritant from inside or outside the body. The central nervous system is necessarily involved in this process.
Reflex is the basis for the functioning of the nervous system; almost all nervous processes occur with the help of reflexes.
During the reflex process, a nerve impulse passes through a reflex arc:
- receptors of certain cells, organs and tissues,
- sensory nerve fibers form and transmit nerve impulses from innervated organs,
- analysis of impulses in the central nervous system,
- motor nerve fibers transmit impulses to innervated organs - a response to a stimulus.
- conditional,
- unconditional.
These reflexes develop as an automatic reaction to external and internal factors. Unconditioned reactions exercise a person’s ability to self-preserve, adapt to environmental conditions, reproduce, and maintain homeostasis - the constancy of the internal state of the body. They are genetically determined and passed on from generation to generation.
Examples of unconditioned reflexes: sucking breast milk by a newborn baby, sexual, maternal and other instincts, blinking when there is a threat of eye injury, coughing and sneezing when foreign particles enter the Airways and so on.
Trigeminal nerve
The trigeminal nerve is the fifth pair of cranial nerves. It got its name due to the presence of three branches:- ophthalmic (superior) branch,
- maxillary (middle) branch,
- mandibular (lower) branch.
Characteristics of the trigeminal nerve
| Options | Characteristic | ||
| Optic nerve | Maxillary nerve | Mandibular nerve | |
| Type of nerves | Sensitive | sensitive | mixed nerve, contains sensory and motor fibers |
| What does it innervate? |
| Skin of the eyelid (lower), upper lip and side of the face, upper teeth |
|
| Main functions | Skin sensitivity, regulation of tear production, sensitivity of the meninges | Skin sensitivity |
|
| Place of exit from the skull | Outer wall of the orbit. | round hole - located under the eye socket. | Foramen ovale – located under the eye socket. |
| Main branches of the nerve |
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|
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| Nerve ganglia** formed by the trigeminal nerve | Eyelash knot:
| Pterygopalatine node:
| Ear node:
|
| Nuclei in the brain | Motor fibers trigeminal nerves are located in the pons (hindbrain) - motor nuclei of the trigeminal nerve. Sensitive fibers The trigeminal nerve passes through the cerebral peduncles and is represented by sensory nuclei in the brain:
|
||
***Nerve nodes or ganglia– an accumulation of nervous tissue containing nerve fibers and nerve centers, connects two or more nerve fibers, receives impulses both from the endings and from the central nervous system (ascending and descending flows).
Rice. No. 1: Ophthalmic and maxillary nerve and their branches.
Rice. No. 2: Mandibular nerve and its branches.
Causes of trigeminal neuralgia
According to the mechanism of occurrence of trigeminal neuralgia, this pathology can be primary or true (isolated damage to only the trigeminal nerve) or secondary (manifestation of neuralgia as a symptom of systemic diseases of the nervous system).The exact cause of the development of trigeminal neuralgia is not clear; as mentioned above, it is an idiopathic disease. But there are factors that most often lead to the development of this disease.
Factors that contribute to the development of trigeminal neuralgia:
- Compression of the trigeminal nerve in the cranium or its branches after leaving the skull:
- cerebral vasodilation: aneurysms (pathological dilatations of blood vessels), atherosclerosis, hemorrhagic and ischemic strokes, increased intracranial pressure as a result of osteochondrosis cervical spine spine, congenital anomalies of vascular development, and so on - the most common reason development of trigeminal neuralgia,
- tumor formations brain or facial area along the branches of the trigeminal nerve,
- injuries and post-traumatic scars,
- injuries in the area of the maxillotemporal joint,
- connective tissue proliferation(adhesions) as a result of an infectious inflammatory process, sclerosis with damage to the myelin sheath of nerve fibers.
- congenital anomalies development of bone structures of the skull.
- Viral nerve lesions: herpes infection, polio, neuro-AIDS.
- Nervous system diseases:
- multiple sclerosis,
- infantile central palsy (CP),
- meningitis, meningoencephalitis (viral, tuberculous),
- encephalopathy due to head injuries, infectious processes, hypoxia (lack of oxygen in the brain), lack of nutrients,
- brain tumors and circulatory disorders in the area of the nuclei and fibers of the trigeminal nerve, and so on.
- Odontogenic causes(teeth related):
- “unsuccessful” filling or tooth extraction or other surgical interventions in the face and oral cavity.
- reaction to anesthesia of dental canals,
- jaw injury with damage to teeth,
- dental flux
Factors that increase the risk of developing trigeminal neuralgia:
- age over 50 years,
- mental disorders,
- chronic fatigue ,
- stress,
- hypothermia of the face (for example, in a draft),
- avitaminosis (lack of B vitamins),
- metabolic disorders: gout, diabetes, thyroid diseases and other endocrine pathologies,
- helminthiasis (worms),
- starvation, impaired absorption of nutrients in the intestines, bulimia, anorexia,
- inflammation with swelling of the mucous membrane of the maxillary and other paranasal sinuses (chronic sinusitis),
- inflammatory processes and ulcers (abscesses, phlegmons) in the oral cavity - gingivitis, pulpitis,
- suppuration of the skull bones, especially the jaws (osteomyelitis),
- acute and chronic infectious diseases with severe intoxication: malaria, syphilis, tuberculosis, brucellosis, botulism, tetanus and so on.
- autoimmune diseases,
- severe allergic diseases.
Mechanism of development (pathogenesis) of trigeminal neuralgia
The pathogenesis of the development of trigeminal neuralgia has been debated by many scientists around the world for many years. Depending on the reasons that contributed to the occurrence of trigeminal neuralgia, two theories of the mechanism of its development:
And although there are “dark spots” in each theory, it is assumed that both mechanisms for the development of pain syndrome take place, that is, they sequentially follow each other. That is why treatment of trigeminal neuralgia should be comprehensively aimed at restoring the myelin sheath of nerve fibers and inhibiting nervous processes in the brain.
Symptoms of trigeminal neuralgia
The main symptom of trigeminal neuralgia is pain in the face, but there are other manifestations and complications of this disease that do not cause such discomfort as unbearable pain, but may additionally indicate trigeminal neuralgia.| Symptom | How does it manifest? | When does the symptom occur? |
| Facial pain | Pain syndrome usually manifests itself in only one half of the face. The pain is paroxysmal or is also called paroxysmal; attacks are replaced by periods of calm. The pain is unbearable, shooting in nature, and is often compared to electric shock. At these moments, the patient freezes in the position in which the attack began, tries not to move, and clasps his hands at the location of the pain. Attacks of pain usually last from a couple of seconds to several minutes. Quiet periods can range from a few hours to several months. Sometimes, with an atypical course or an advanced long-term course of the disease, pain in the face and head is almost constant. With the duration of the disease, the duration of attacks increases, and the period of remission shortens. |  Pain usually appears after exposure to irritating factors. There are zones on the face, so-called trigger zones (in the literature you can find the term algogenic zones), with slight irritation of which a painful attack can begin. Moreover, rough influence on these points during an attack often leads to its relief (cessation). Localization of trigger points is individual:
 Rice. Possible trigger zones for trigeminal neuralgia. |
Localization of pain****
| With damage to the ophthalmic branch of the trigeminal nerve. | |
| With damage to the maxillary branch of the trigeminal nerve. | |
| With damage to the mandibular branch of the trigeminal nerve. | |
| With damage to all branches of the trigeminal nerve and with the central cause of neuralgia (brain tumors, etc.).  |
|
| Redness of the face and sclera, increased salivation, lacrimation, the appearance of mucous discharge from the nose | These symptoms are localized on the affected side and appear during a painful attack. | Facial hyperemia and increased production of the salivary, lacrimal glands and nasal mucous glands are associated with disorders of the autonomic nervous system, the branches of which are part of the sensory fibers of the branches of the trigeminal nerve. |
| Twitching of facial muscles | Muscle tremors are similar to mild local convulsions or nervous tics and occur against the background of pain. In this case, chewing and facial muscles are involved. There may be a narrowing of the palpebral fissure on the affected side, associated with spasm of the eyelids. | Muscle twitching is associated with a reflex spread of increased excitability to the motor fibers of the trigeminal nerve and other cranial nerves innervated by the facial muscles.  Photo of a patient during an attack of trigeminal neuralgia. |
| Mental disorders | The patient becomes irritable, feelings of fear and anxiety appear. When laughing, talking, or eating leads to the development of pain, the patient withdraws, remains silent, and refuses to eat. In severe cases, suicidal tendencies (desire to commit suicide) may occur. | Mental disorders in the patient arise against the background of frequent debilitating attacks of unbearable pain, the duration of the disease (years), the occurrence of attacks against the background of minor factors irritating trigger zones. Patients develop apathy, psychosis, phobias, depression, and so on. |
| Loss of facial sensitivity (paresthesia) | A feeling of tingling, crawling on the affected side. A dull aching pain may appear, reminiscent of toothache due to caries and pulpitis (which brings patients to the dentist). Sometimes there is a lack of skin sensitivity along the branches of the trigeminal nerve. | This symptom occurs in a third of patients and is usually a harbinger of an upcoming painful attack (several days or several months before the paroxysm). Paresthesia is associated with widespread damage to the myelin sheath of nerve fibers, which leads to disruption of their sensitivity in the direction of increased excitation and disruption of the conduction of nerve impulses along the sensitive nerve fibers. |
| Impaired blood circulation and lymphatic drainage (trophic changes) |
| Trophic disorders along the trigeminal nerve can occur after several years of illness. Due to a violation of the innervation of the muscles and skin of the face by the trigeminal nerve, prolonged and frequent pain attacks, there is a violation of blood circulation and lymph flow on the affected half of the face. This leads to tissue malnutrition (lack of oxygen and nutrients). In order not to irritate trigger zones, the patient spares the painful side of the face: chews on the healthy side, does not smile, does not open his mouth wide, and so on. Over time, this leads to atrophy of the chewing and facial muscles (reduction of muscle tissue, decrease in their functions), which in turn also leads to impaired trophism of the muscles and skin of the face.  Photo of a patient with atrophy of the facial muscles on the right side. |
****Trigeminal neuralgia usually develops on one side and is most often right-sided. As the disease progresses, the location of the pain does not change. Only with severe pathologies of the brain is it possible over time for the process to spread to the second half of the face.
Diagnosis of trigeminal neuralgia
Examination by a neurologist
- Anamnesis (history) of life: the presence of factors and diseases that could cause trigeminal neuralgia (tumors, vascular pathology of the brain, previous diseases, surgical interventions in the oral cavity or on the face, and so on).
- History of illness:
- the onset of the disease is acute, sudden, patients clearly remember when, where and under what circumstances the first attack of paroxysmal pain began,
- attacks of pain alternate with periods of remission,
- pain syndrome provokes even slight irritation of one of the trigger zones of the trigeminal nerve,
- one-way process
- pain is not relieved by anti-inflammatory and analgesic drugs.
- Complaints for attacks of acute unbearable pain that appears suddenly after irritation of trigger zones, and the appearance of other symptoms of trigeminal neuralgia (shown in the table above).
- Objective examination during the interictal period:
- General state usually satisfactory, consciousness is preserved, neurotic reactions and disturbances in the patient’s mental state are possible.
- Upon examination of the patient won't let you touch your face in the area of trigger zones, he himself points to them, without bringing his finger to the skin or mucous membrane.
- The skin is often unchanged, with a severe long-term course of the disease, dry skin, the presence of peeling, folds and wrinkles, facial asymmetry, drooping of the upper eyelid and other symptoms of facial muscle atrophy are possible. Visible mucous membranes are not changed.
- Sometimes there is a disturbance in the sensitivity of the facial skin (paresthesia).
From the internal organs(cardiovascular, respiratory, digestive and other body systems) usually no pathological changes are detected during examination. - Neurological status in patients with trigeminal neuralgia without pathology of the central nervous system, it is not changed. There are no pathological reflexes or signs of inflammation of the meningeal membranes (meningeal signs).
- Objective examination of the patient during an attack of paroxysmal pain:
- Pain occurs after exposure to the trigger zones of the trigeminal nerve, and the pain syndrome itself spreads only along the branches of the trigeminal nerve.
- Patient position: freezes or tries to stretch his facial muscles with his hands, does not answer questions or answers in short phrases. The patient looks very frightened and suffering.
- On the skin perspiration (sweat) appears on the face, the skin of the affected side of the face and the mucous membrane of the sclera turns red, lacrimation is possible, the patient often swallows due to increased saliva secretion, mucous discharge may appear from the nose in a stream.
- Possible appearance convulsive twitching facial muscles on one side.
- Breath the patient's blood pressure decreases or becomes more frequent.
- Pulse becomes more frequent (more than 90 per minute), blood pressure does not change or increases slightly. By pressing on the trigger points of the trigeminal nerve, the attack of pain can be temporarily stopped.
- When conducting novocaine blockade trigeminal nerve (introduction of novocaine along the branches of the trigeminal nerve, basically these are the trigger points) the attack temporarily stops.
The diagnosis is made on the basis of specific complaints, the presence of trigger zones, localization of pain along the branches of the trigeminal nerve, the appearance of the above symptoms during an attack, an objective examination, and instrumental diagnostic data.
Instrumental research methods
Magnetic resonance imaging (MRI) of the brain and spinal cord MRI– most informative a method for studying the structures of the brain, its vessels, nuclei and branches of cranial nerves.
This method is visual (that is, we get an accurate three-dimensional image on the screen and on paper), however, unlike X-ray methods, MRI is based on magnetic rather than radiation. That is, it is safe for the patient.
If trigeminal neuralgia is suspected, MRI is necessary to identify or exclude brain tumors, vascular disease, the presence of diffuse or multiple sclerosis and other possible causes of the disease.
For a more accurate study of cerebral vascular pathologies, MRI is used with the introduction of a contrast agent into the vessels (angiography).
Disadvantages of the method:
- high cost of research;
- contraindications: the presence of metal objects in the body (remnants of fragments, pacemakers, metal plates that are used for osteosynthesis for complex bone fractures, metal dentures, crowns), heavy psychological illnesses, claustrophobia.
Computed tomography (CT) CT– an x-ray diagnostic method that allows layer-by-layer visualization of the structures of the brain and spinal cord. In terms of information content, it is slightly inferior to magnetic resonance imaging, since MRI allows you to create a three-dimensional image, and CT allows you to create a two-dimensional image. CT can identify diseases of the central nervous system that could lead to the development of trigeminal neuralgia.
The main disadvantage of computed tomography is the high radiation exposure and high cost (but the CT method is more accessible and cheaper than MRI). 
Electroneurography
Electroneurography – an instrumental method for studying the nervous system that allows one to determine the speed of electrical current (impulse) along the nerve fibers of peripheral nerves.
What does electroneurography reveal?
- the presence of nerve damage,
- level of damage (that is, where exactly),
- pathogenesis of the lesion (damage to the myelin sheath or damage to the axon),
- prevalence of the process.
- demyelination(damage to the myelin sheath of axons), which is a key factor in the pathogenesis of trigeminal neuralgia,
- other nerve changes, characteristic of other nerve lesions, allowing to differentiate diseases of the nervous system.
Electroneuromyography (ENMG)
ENMG– a type of electroneurography, allows you to study the speed of passage of electric current along a peripheral nerve with a parallel study of the reaction of the muscles that are innervated by this nerve.
In addition to those parameters that electroneurography reveals, ENMG reveals pain tolerance and the sensitivity threshold of possible trigger zones of the trigeminal nerve, as well as the degree of contraction muscle fibers in response to increased nerve stimulation.
Electroencephalography (EEG)
EEG– a method for diagnosing the nervous system, in which a special electroencephalograph apparatus records the biological electrical activity of the brain, depicting them in the form of curves. This method allows you to identify structures through which the passage of impulses is disrupted.
What is revealed by EEG during a paroxysmal attack of trigeminal neuralgia?
- changing curves in synchronized or unsynchronized type,
- signs of epileptic foci in the hindbrain and midbrain, in the locations of the trigeminal nerve nuclei.
Additional consultations with narrow specialists for trigeminal neuralgia
- ENT – it is necessary to identify and, if necessary, treat chronic diseases of the nasopharynx.
- Neurosurgeon - when identifying a pathology of the central nervous system, which could lead to the development of neuralgia, it is necessary to decide on the need for surgical treatment.
- Dentist - to carry out differential diagnosis of trigeminal neuralgia with dental diseases and, if necessary, sanitize the oral cavity.
Laboratory research methods
With trigeminal neuralgia, laboratory diagnostics are not very informative; usually the biochemical parameters of blood and other biological fluids are normal. At the moment, there are no specific laboratory indicators indicating neuralgia, in general, including trigeminal neuralgia.But while taking medications to treat neuralgia, it is necessary to monitor their tolerance. To do this, biochemical studies of the liver, general analysis of urine and blood are periodically carried out.
If there are symptoms of inflammation of the meningeal membranes (meningeal signs), it is necessary to perform a spinal puncture, followed by laboratory testing of the cerebrospinal fluid (CSF). This is necessary to exclude meningitis.
In case of herpetic lesions of the trigeminal nerve, it is necessary to monitor the level of immunoglobulins A, M, G to herpes types I, II, III.
Treatment of trigeminal neuralgia
Treatment of trigeminal neuralgia should be comprehensive:- elimination of the causes that provoked the development of trigeminal neuralgia.
- decreased excitability of the central nervous system;
- stimulation of restoration of the myelin sheath of the damaged trigeminal nerve - at the moment there are no means to completely restore myelin, scientists around the world are working on the development of such an effective drug, but some measures are used to stimulate the restoration of the myelin sheath;
- physiotherapeutic effects on the branches of the trigeminal nerve and trigger zones.
Drug treatment of trigeminal neuralgia
| Group of drugs | A drug | Mechanism of action | How to use? |
| Anticonvulsants(selection of the drug and its dose is carried out individually) | Carbamazepine (finlepsin) | Effects of taking anticonvulsants:
Other effects: release of glutamate (a neurotransmitter that promotes inhibition of nerve impulses) and inhibition of the production of neurotransmitters that promote the excitation of nerve fibers (dopamine and norepinephrine). Attention! Anticonvulsants are classified as psychotropic medicines and have many side effects, so they are sold in pharmacies only with a doctor’s prescription. | The drug is administered gradually in small doses, then the dosage is increased. Treatment is started with 100-200 mg 2 times a day, then increased to 400 mg 2-3 times a day until pain attacks stop. Later, you can reduce the dose to maintain the therapeutic effect to 100-200 mg 2 times a day. The treatment is long-term. |
| Phenytoin (diphenin) | Start with a dose of 3-5 mg per kg per day, then increase the dose to 200-500 mg per day. The dose is taken once or divided into 2-3 doses, only after or during meals. The treatment is long-term. | ||
| Lamotrigine | The initial dose is 50 mg 1 time per day, then the dose is adjusted to 50 mg 2 times per day. The treatment is long-term. | ||
| Gabantine | The mechanism of action of this drug is not known; its high effectiveness in treating trigeminal neuralgia has been experimentally proven. | The initial dose is 300 mg per day, maximum 1800 mg per day. The drug is taken in 3 doses. | |
| Stazepin | Start with 200 mg per day, increase the dose to 600 mg per day. Take in 3 doses. | ||
| Muscle relaxants | Baclofen (baclosan, lioresal) | Baclofen is effective in treating neuralgia by stimulating the production of the neurotransmitter GABA (gamma-aminobutyric acid). Effects of using muscle relaxants:
| The initial dose is 15 mg in 3 doses, then gradually it is increased to 30-75 mg per day in 3 doses. |
| Mydocalm |
| The initial dose is 150 mg per day in 3 doses, the maximum dose is 450 mg per day in 3 doses. | |
| Vitamin preparations | B vitamins (neuromultivit, neurovitan and other complexes) |
| 1 tablet 3 times a day with meals. |
| Omega-3 unsaturated fatty acids (dietary supplement) | Unsaturated fatty acids are the material for the structure of myelin. | 1-2 capsules per day with food. | |
| Antihistamines | Diphenhydramine, pipalfen | Strengthen the effect of anticonvulsants. | Diphenhydramine 1% 1 ml before going to bed at night, Pipalfen 2.5% - 2 ml before bedtime in the form of injections. |
| Sedative and antidepressant drugs | Glycised (glycine) | Glycine is an amino acid that is a neurotransmitter that inhibits the processes of excitation of the nervous system. It has a calming, anti-stress effect and normalizes sleep. | Dissolve 2 tablets 3 times a day under the tongue. |
| Aminazine | Aminazine blocks receptors that receive impulses from transmitting nerve fibers. Thanks to this, the drug has a calming effect and reduces psychotic reactions in acute and chronic psychoses. | 20-100 mg every 4-6 hours orally. Injection of the drug is necessary for acute psychotic reactions. A single dose of 25-50 mg is administered; if necessary, the drug is re-administered. This drug is continued until the patient’s mental state normalizes. | |
| Amitriptyline | It has an antidepressant effect due to the regulation of the release of neurotransmitters. | Initial dose: 75 mg in 3 doses, then increase the dose to 200 mg in 3 doses. It is recommended to take the drug during meals. |
In case of severe trigeminal neuralgia, constant pain, it is recommended to prescribe even narcotic drugs (sodium hydroxybutyrate, cocaine, morphine, and so on).
Previously, blockades of the branches of the trigeminal nerve with 80% ethyl alcohol (alcoholization), glycerin and novocaine were widely used. However, at the moment, it has been proven that, despite the rapid analgesic effect, these procedures contribute to additional trauma and destruction of the myelin sheath of the trigeminal nerve, which in the future (after just six months) leads to the progression of the disease with short remissions and long-term attacks of pain.
Be sure to carry out correction of those conditions that may have led to the development of the disease:
- treatment of ENT pathology,
- therapy for cerebrovascular diseases,
- adequate sanitation of the oral cavity,
- antibacterial (or antiviral) and immunocorrective treatment of infectious diseases,
- prevention of connective tissue growths (scars) after injuries, surgical treatment and infectious processes, for this purpose it is effective to prescribe biostimulants (aloe extracts, placenta, FiBS), short courses of small doses of glucocorticosteroids (hormones) and physiotherapy procedures,
- normalization of metabolism, in case of its disorders (diet, vitamin therapy, hormonal correction, and so on),
- other measures, depending on the causative diseases and conditions.
Surgical treatment for trigeminal neuralgia
Surgical treatment of trigeminal neuralgia is recommended if it can effectively solve the problem with minimal risks postoperative complications. They also offer facilitating surgical procedures in the absence of clinical effect from the drug therapy (after 3 months of no positive results).- Prompt solution to problems that cause neuralgia:
- removal of brain tumors(the extent of the operation is determined by the type, location and extent of the tumor process),
- microvascular decompression– displacement or resection (removal) of dilated vessels that put pressure on the trigeminal nerve or its nuclei,
- widening of the narrowed infraorbital canal(the exit point of the trigeminal nerve) is a low-traumatic operation on the bones of the skull.
With the effective elimination of the causes that caused compression of the trigeminal nerve, attacks of trigeminal neuralgia often go away, and the outcome is recovery.
- Surgical intervention aimed at reducing the conductivity of the trigeminal nerve:
- Cyber Knife– modern effective treatment trigeminal neuralgia. Moreover, unlike other traumatic operations, the risk of complications is minimal (on average 5%). Cyber Knife is a type of radiosurgery that does not require punctures, incisions or other traumatic manipulations. It can be carried out outside a hospital hospital (outpatient).
This method is based on the impact of a thin beam of radiation on the area of increased excitability of the nerve fibers of the trigeminal nerve or its nucleus. - Gamma Knife as well as Cyber Knife - a method of radiosurgery in which beams of radiation destroy the trigeminal ganglion. It also has a low risk of complications. Its effectiveness is inferior to Cyber Knife.
- Balloon compression of the trigeminal ganglion – A catheter is inserted through the skin into the area of the trigeminal nerve ganglion, through which a balloon is installed and filled with air. This balloon compresses the ganglion, over time destroying the branches of the trigeminal nerve, thereby eliminating the conduction of nerve impulses into the central nervous system. This method has a temporary effect and can lead to the development of complications (numbness of the face, distorted facial expressions, impaired chewing).
- Trigeminal ganglion resection- a complex traumatic operation that requires craniotomy, removal of the ganglion by excision with a scalpel and long postoperative recovery, and also has a high risk of complications.
- Other types of surgical operations aimed at removing the trigeminal ganglion or branches of the trigeminal nerve are traumatic and often cause complications.
- Cyber Knife– modern effective treatment trigeminal neuralgia. Moreover, unlike other traumatic operations, the risk of complications is minimal (on average 5%). Cyber Knife is a type of radiosurgery that does not require punctures, incisions or other traumatic manipulations. It can be carried out outside a hospital hospital (outpatient).
- capabilities of the medical institution and surgeons,
- financial capabilities of the patient (radiosurgery methods are quite expensive),
- the presence of concomitant diseases,
- general condition of the patient,
- the reasons that led to the development of neuralgia,
- the presence of individual indications and contraindications for a certain type of surgery,
- patient's reactions to drug treatment,
- the risk of developing postoperative complications and so on.
Physiotherapy for trigeminal neuralgia
Physiotherapy– effective measures for relieving pain in trigeminal neuralgia. Depending on the degree of damage, the frequency of relapses, and the cause of neuralgia, one or another method of physical influence on the trigeminal nerve or its nuclei is prescribed. Physiotherapy methods
| Method | Effect | Principle of the method | Duration of treatment |
| Ultraviolet irradiation (UVR) of the face and neck | Relieving pain syndrome. | Ultraviolet irradiation (namely medium wave) promotes the release of neurotransmitters that inhibit the excitation of nerve fibers and natural analgesics. | 10 sessions |
| Laser therapy |
| The laser is applied to the localization areas of each branch of the trigeminal nerve, as well as the nodes formed by this nerve. Laser irradiation inhibits the sensitivity of nerve fibers. | On average, 10 procedures of 4 minutes are recommended. |
| UHF |
| Exposure to ultra-high frequencies promotes:
| 15-20 sessions of 15 minutes each |
| Electrophoresis |
| Electrophoresis is the introduction of medicinal substances using an electric current directly into the desired area of the nerves. To relieve pain the following is administered:
Also, using electrophoresis, you can introduce B vitamins, which will improve the nutrition of the nerve and damaged myelin sheath. | It is better to alternate these procedures with other methods of physiotherapy every other day, for a total of 10 procedures. |
| Diadynamic currents |
| For this method, Bernard currents are used, which are electric currents with a pulse of 50 thousand hertz. Electrodes are placed on the area of trigger zones of the trigeminal nerve, including the nasal mucosa. Bernard current reduces the threshold of pain sensitivity, blocks the branches of the trigeminal nerve, thereby reducing the intensity of the pain syndrome until it stops completely. The use of diadynamic currents in combination with electrophoresis and other methods of physiotherapy is effective. | Several courses of 5 days with a break of 5-7 days, the procedure lasts for 1 minute. |
| Massage | Prevention and treatment of atrophy of facial and masticatory muscles. | Massaging the muscles of the face, head and neck improves blood circulation and lymph flow, thereby improving their nutrition. The massage is carried out carefully; it should not affect trigger zones and provoke the development of pain attacks. Use movements of stroking, rubbing, and vibration. A course of massage is prescribed only against the background of stable remission of the disease. | 10 sessions. |
| Acupuncture (acupuncture) | Relieving pain syndrome. | Acupuncture affects nerve receptors that transmit impulses to nerve fibers. In this case, several points are selected in the trigger zones and several points remotely on the opposite side. Sometimes the needles are installed for a long period - a day or more, periodically scrolling them. | The duration of treatment is selected individually; often only a few procedures are enough.  |
All physiotherapeutic treatment methods should be used in combination with drug therapy and the elimination of factors that led to the development of the disease, since physical procedures are powerless as monotherapy (mono-one).
Prevention of trigeminal neuralgia
- Timely seeking medical help for the treatment of acute and chronic diseases of the ENT organs, timely sanitation of the oral cavity, and so on.
- Annual preventive medical examinations in order to identify diseases of internal organs, endocrine glands, nervous and cardiovascular pathologies.
- Avoid injury to the face and head.
- Avoid drafts and other types of hypothermia.
- Control of blood pressure and treatment of hypertension, vegetative-vascular dystonia, atherosclerosis and other vascular diseases.
- Healthy lifestyle:
- full physical activity,
- proper sleep and rest,
- adequate response to stressful situations,
- proper healthy diet containing sufficient amounts of vitamins, microelements, unsaturated fatty acids and amino acids.
- hardening,
- quitting smoking, drug and alcohol abuse, etc.
- You cannot self-medicate pain in the facial area, remember that any manipulation can aggravate the course of trigeminal neuralgia.
Be healthy!
Scientists call this disease Trousseau's painful tic and Fothergill's disease; patients know it as trigeminal neuralgia. You can independently determine the pathology by paroxysmal, extremely intense pain in the eyes, forehead, and jaw. If this distinctive sign is detected, you should immediately contact a medical institution; even a single symptom that occurs is a reason to begin treatment for trigeminal neuralgia as soon as possible.
Anatomical structure
The fifth pair of cranial nerves is called trigeminal, they are located symmetrically: on the right and left sides of the face. The function of the trigeminal nerve is to innervate a number of facial muscles. It consists of three main branches, which include many smaller branches. The path of branches to innervated areas passes through channels in the bones of the skull, where nerve fibers can be subject to compression.
Causes of trigeminal neuralgia
Identifying the origin of neuralgia allows you to objectively assess the clinical picture and cure the patient quickly and with minimal stress on the body. Doctors consider the most common causes of trigeminal neuralgia to be:
- vascular pathologies, including changes and anomalies in the development of blood vessels or their location;
- deterioration of blood flow due to hypothermia of the facial area;
- inflammatory processes in the branching area, which can be caused by otorhinolaryngological, eye and dental problems;
- facial and skull injuries;
- disruption of metabolic processes in the body;
- viral diseases in chronic form;
- congenital narrowness of the canals along the branches;
- any tumors localized in the trigeminal nerve area;
- multiple sclerosis;
- allergic inflammation;
- stem stroke;
- psychogenic factors.
Risk group and characteristics of the disease
Trigeminal neuralgia is a very common reason for visiting a neurologist. This is due to a large number of factors that provoke the development of the disease, painful attacks of extremely high intensity and long-term therapy for advanced cases. The number of people at risk for trigeminal neuralgia is quite large.
Middle-aged people are more often susceptible to neuritis; the disease mainly manifests itself between the ages of 40 and 50 years. The percentage of patients suffering from trigeminal neuralgia among women is much higher than among men. An important determining factor is the presence of chronic diseases in the patient’s history that contribute to the development of neuralgia.
In seventy percent of cases, the right side is affected; both sides are extremely rarely affected. The course of the pathology is cyclical: the acute period is followed by remission. Peaks of exacerbations occur in autumn and spring.
Symptoms of facial trigeminal neuralgia
Fothergill's disease has obvious symptoms, obvious even to a non-specialist. However, how to effectively treat trigeminal neuralgia can only be determined by a doctor who takes into account the entire clinical picture.
Symptoms of Trousseau's pain tic are divided into three groups, which manifest themselves in stages: at first only painful sensations are disturbing, then motor and reflex, and then vegetative-trophic disorders. At the third stage, not only the symptoms undergo changes, but also the medical prognosis for complete healing worsens significantly.
Nature of pain
The first sign of Trousseau's pain tic is intense pain attacks in the innervation zone of the affected branch. The pain is burning and excruciating, characterized by extreme intensity, it is paroxysmal and occurs very abruptly.
Patients compare a painful attack of neuralgia with a lumbago and the passage of an electric current. The paroxysm lasts from several seconds to several minutes. At the time of exacerbation, the frequency of attacks is very high.
According to a scientific article devoted to the study of the disease, a painful attack due to neuralgia can occur up to three hundred times per day.
Localization of pain
Pain can be localized both in the innervation zone of the entire nerve and in one of its branches. A characteristic feature is that the pain spreads from one branch to another, and over time the entire affected half of the face is involved. The longer the disease goes on without medical intervention, the more likely it is that the entire nerve will be affected. and spread of the pathological process to other branches.
With lesions of the ophthalmic branch, the pain is concentrated in the forehead and eye. With a disease of the maxillary branch, pain spreads across the upper and middle part of the face. Lesions of the mandibular nerve can provoke pain in the area of the masticatory muscles, lower jaw and wings of the nose. Sometimes echoes of pain are felt in the neck, temple and back of the head.
It happens that the pain is clearly concentrated in the area of a specific tooth, which is why the dentist is often the first specialist for whom a patient with neuralgia makes an appointment. When examining a tooth, the cause of pain is not revealed, but if treatment is carried out, it does not bring any effect or relief. The main task of the dentist in such a situation is to refer the patient for a consultation with a neurologist.
Provocation of pain
Painful paroxysm can be provoked by touching or pressing on the exit points of the nerve branches in the facial area and trigger zones. Everyday activities, such as chewing and brushing teeth, washing, shaving, even blowing wind, speaking and laughing, can also cause an attack of pain. At the moment when an attack occurs, the patient often freezes, afraid to make the slightest movement, and lightly rubs the pain area.
Motor and reflex disorders
- Facial muscle spasm. At the moment of paroxysm, the facial muscles involuntarily contract. Reflex disorders begin with blepharospasm or trismus; as the disease progresses, spasms can spread to the entire half of the face.
- Degradation of the superciliary, corneal and mandibular reflexes. The disorder is detected during examination by a neurologist.
Vegetative-trophic symptoms
At the initial stage of the disease, vegetative-trophic symptoms are practically absent, or symptoms appear exclusively during an attack. The only characteristic features are the occurrence of painful paroxysm, local redness or pallor of the skin. The secretion of the glands changes, a runny nose, lacrimation and drooling may appear.
As the disease progresses, the vegetative-trophic symptoms of trigeminal neuralgia intensify, and therefore longer and more extensive treatment is required.
Symptoms of an advanced case of neuralgia
In advanced cases, a number of other symptoms are added. Eliminating the cause of the disease no longer leads to recovery in one hundred percent of cases; complex treatment methods are required.
Signs of advanced trigeminal neuralgia are:
- Swelling of the face, loss of eyelashes, changes in the secretion of the skin glands.
- Spread of pain to other parts of the face.
- The appearance of pain from the slightest pressure on any part of the face on the affected side.
- The occurrence of pain in response to any irritant, even a loud sound or bright light, can even be a contributing factor, even a reminder of a previous attack.
- Permanent nature of the pain.
- Changes in the location and duration of pain attacks.
- Increased vegetative-trophic symptoms.
Diagnostics
Correct treatment of trigeminal neuralgia requires identifying all the symptoms; they will help determine the stage and specifics of the disease. Anamnesis and questioning of the patient are of utmost importance in making a diagnosis. The examination helps to determine the location of the decrease and increase in skin sensitivity on the face, and to identify possible degradation of muscle reflexes.
During the period of remission of the disease, if it is at an early stage, the pathology is not always noticeable upon examination. To detect the cause of neuritis, an MRI may be recommended to the patient, however, even the most modern tomography performed in Moscow does not always show pathology. Patients with symptoms of neuralgia are advised to immediately visit a neurologist.
Methods of treating Fothergill's disease
Treatment of trigeminal neuralgia is carried out using the following methods, mainly used in combination:
- physiotherapy;
- prescription of drugs;
- surgical intervention.
Attempts to cure with all sorts of folk remedies are not only ineffective for neuralgia, but also very dangerous. The main risk is that time will be lost and qualified assistance will not be provided on time.
Treatment with medications
Prescription of drug treatment is justified when the cause of trigeminal neuralgia is vascular pathology or a tumor. The therapy involves:
- Antiepileptic drugs.
- Painkillers or injections.
- Muscle relaxants.
- Antiviral agents.
The main medication in most cases is an anticonvulsant drug based on carbamazepine. Vitamin-based auxiliary therapy has proven itself well. In addition, they are used for treatment.
- Valproic acid.
- Pregabalin.
- Baclofen.
- Gabapentin.
- Lamotrigine.
The doctor selects the optimal medications and dosages individually. The main goals of therapy are to relieve pain attacks, eliminate the causes of the disease, and prevent complications. Treatment of trigeminal neuralgia with medications takes about six months with a gradual reduction in drug doses.
Surgery
It is better to perform surgery in the early stages of the disease, this increases the likelihood of complete healing. Today, two main groups of operations are used to treat neuralgia. One is effective in cases where it is necessary to correct the position of the artery, or if neuralgia is caused by compression of the nerve branch by some anatomical formation. The second is used if neuralgia was treated with conservative methods, and the therapy did not produce positive results.
The type of surgical intervention varies depending on the pathology that caused neuralgia:
- If the cause of compression is vascular pathology, the microvascular decompression method is used. This is a microsurgical operation during which the nerve and vessel are separated. The effectiveness of the method is very high, but it must be taken into account that the operation is traumatic.
- If the reason is the development of a tumor process, the tumor is first removed, and only after that treatment is prescribed.
- If it is necessary to relieve pain impulses along the nerve fiber, percutaneous balloon compression is performed.
In some cases, destruction of the nerve is necessary. The following methods are used for this:
- Non-invasive ionizing radiation. Used only in the early stages of the disease.
- Stereotactic percutaneous rhizotomy. The nerve root is destroyed under the influence of electric current, which is applied to the damaged area using a very thin electrode.
- Radiofrequency ablation, in which nerve fibers are destroyed by high temperature.
- Glycerin injections into the nerve branching sites.
Physiotherapeutic treatment
To quickly relieve pain symptoms and complete healing, physiotherapeutic procedures are prescribed in tandem with drug therapy. After the start of treatment, surgical or physiotherapeutic, the pain does not recede immediately. The period of complete disappearance of paroxysm is individual and is determined by the extent of the process and the duration of the disease, so the doctor additionally prescribes painkillers.
The following procedures show the greatest effectiveness in the treatment of Trousseau's painful tic:
- laser therapy;
- diadynamic currents;
- electrophoresis using novocaine;
- acupuncture;
- ultraphonophoresis using hydrocortisone.
Preventive measures
It is impossible to avoid all potentially dangerous factors, especially considering that some causes are congenital: narrowness of the canals, pathologies in the structure and location of blood vessels. However, you can reduce the risk of developing the disease by eliminating several provoking factors. As primary prevention you should:
- avoid hypothermia of the face and head;
- promptly treat diseases that can give rise to trigeminal neuralgia;
- avoid head injuries.
Doctors consider only timely treatment of diseases of the trigeminal nerve to be a complete secondary prevention, so at the first symptoms of pathology you should immediately contact the clinic.
Possible complications
It is impossible to trigger trigeminal neuralgia, Fothergill's disease causes complications:
- paresis of facial muscles;
- hearing loss;
- irreversible damage to the nervous system, including inflammation in the brain.
It is categorically impossible to relieve pain with analgesics and hope that neuralgia will go away on its own. This is a serious neuralgic disease that should only be treated by a doctor. The sooner the patient seeks help, the more successful and less lengthy the therapy will be.
Update: December 2018
Before describing the symptoms of trigeminal neuralgia, let's try to explain what the trigeminal nerve is. As is known, in human body 12 pairs of cranial nerves. The trigeminal nerve is a representative of the fifth pair. It consists of three branches - ophthalmic, mandibular and maxillary. Thus, if the ophthalmic branch of the nerve is affected, the pain will be localized in the forehead, temple, and brow ridge.
When the 2nd branch is affected, pain manifests itself in the area of the nose, upper jaw, and facial muscles. Damage to the 3rd branch is characterized by pain localized in the area of the lower jaw, chin, and neck. Often, when the second and third branches are affected, severe toothache occurs.
Types of neuralgia
Conventionally, all types of trigeminal neuralgia can be divided into primary (true) and secondary neuralgia.
- Primary (true) neuralgia is considered a separate pathology that occurs as a result of compression of the nerve or impaired blood supply in this area.
- Secondary neuralgia is the result of other pathologies. These include tumor processes and severe infectious diseases.
Neuralgia can affect all nerve branches at once, or manifest itself as inflammation of one or two branches.
Causes of neuralgia
In order to select adequate treatment for trigeminal neuralgia, you need to have a good understanding of the causes of the disease. And there are many of them:
- Compression of all or one branch of the trigeminal nerve;
- Inflammatory diseases of the paranasal sinuses
- Dental diseases;
- Chronic infectious diseases – tuberculosis, brucellosis, malaria;
- Metabolic disorders - diabetes, gout
- Brain tumors (see)
Signs of the disease
Trigeminal neuralgia produces fairly clear symptoms, so diagnosing the disease does not cause difficulties. The disease is characterized by the appearance of a sharp, burning pain in the face that occurs suddenly. The painful attack does not last long, for a maximum of 2 minutes or seconds (10-20), after which it goes away on its own. As we wrote above, pain occurs in the area where one of the three branches of the nerve is affected. Patients who suffer most are those in whom all three branches of the trigeminal nerve are affected.
The pain always occurs on one side of the face. Sometimes it can be transient - affecting one branch of the nerve, then another. The pain radiates to the eye, ear, neck, and occipital region; patients call this pain shooting and compare it to an electric discharge.
An attack of neuralgia is accompanied by convulsive contractions of the facial (facial, chewing) muscles, while the patient does not scream or cry, but tries to minimize movements. Patients experience increased salivation, lacrimation, and sweating (see). The skin turns red and signs of rhinitis may appear.
Pain occurs both for no apparent reason and with additional irritations: talking, shaving, chewing. During the periods between painful attacks, no signs of the disease can be detected. Sometimes there is mild pain if you press on the exit points of the facial nerve.
Typically, the location of the pain remains unchanged for several years. Since patients with such neuralgia more often chew food on the healthy side, over time, muscle thickening, dystrophy of the masticatory muscles, and decreased sensitivity may occur on the affected part of the face.
The disease is characterized by excruciating pain. When collecting anamnesis and examination, doctors note that patients talk with horror about the pain they suffered, trying not to touch the area of the face where the attack occurred. Patients are usually tense and anxious in anticipation of an exacerbation of neuralgia. This must be taken into account when choosing a treatment method for trigeminal neuralgia - it is very important to reassure the patient, instill in him confidence that the treatment will be effective and the pain will not return.
Which doctor should I contact? Having experienced an attack of severe facial pain, especially if it manifests itself in the area of the jaws and teeth, most patients associate its occurrence with dental pathologies. This is not true. Your road lies to a doctor - a neurologist.
How to treat trigeminal neuralgia?
To treat this disease, medication, physiotherapy and surgery are used.
Drug treatment
Carbamazepine is considered the main drug for the treatment of trigeminal neuralgia. It develops inhibitory processes in nerve cells that are prone to paroxysmal activity (painful excitation). The dosage of the drug is selected by the doctor, so we will not dwell in detail on the drug regimens used. Let's just say that carbamazepine is taken for a long time, up to 8 weeks.
In addition, the drug is quite toxic. Affects the liver, urinary and bronchial systems. Side effects from taking carbamazepine include various mental disorders, memory impairment, and drowsiness.
Carbamazepine is contraindicated in pregnant women. The drug has a teratogenic effect - it has a toxic effect on the embryo. Carbamazepine should also not be taken by persons with glaucoma, heart blocks, or blood diseases.
Interesting! It is known that when taking carbamazepine you should not drink grapefruit juice - it enhances the toxic effect of the drug.
We hope that we have convinced you not to take carbamazepine under any circumstances without a doctor’s prescription. When taking this drug for trigeminal neuralgia, the symptoms stop after 1-2 days, its analgesic effect is felt, which lasts 3-4 hours.
- Similar drugs, anticonvulsants, can also be used in the complex treatment of trigeminal neuralgia. These are Phenibut, Pantogam, Baclofen.
- To relieve a painful attack, ambulance specialists can use intravenous administration of sodium hydroxybutyrate. However, the effect of such injections is short-lived; pain is relieved for several hours.
- may enhance the therapeutic effect of carbamazepine (Pipolfen, Diphenhydramine).
- Tranquilizers (Tazepam, Diazepam) and antipsychotics (Pimozide) are prescribed; as an additional drug, neurologists can use a drug that is well known to you over a long course.
- For diseases of the cerebral vessels, vasotonics can be prescribed - Cavinton, Trental, Nicotinic acid, etc.
- Vitamin therapy, especially vitamin C and B vitamins. The latter are often prescribed in injection form during the acute period of the disease.
- Non-steroidal anti-inflammatory drugs - see.
Physiotherapeutic treatment
Physiotherapeutic treatment is prescribed in combination with medication. The following methods are used: 
- Acupuncture;
- Ultrasound;
- Laser treatment;
Radical treatment
If there is no effect from conservative treatment, the patient may be offered a surgical solution to the problem. Currently, there are several types of radical treatment. Let's take a closer look at these methods:
- Rhizotomy
The trigeminal nerve is ruptured through a skin incision behind the ear, which achieves a therapeutic effect.
- Microvascular decompression
The operation is performed by neurosurgeons. In this operation, blood vessels that come into contact with the nerve roots are removed or relocated. The effectiveness of such an operation reaches 80%.
- Radiofrequency ablation
Impact on the nerve ganglion high temperature. Treatment is carried out using local anesthesia. Hospitalization is not necessary. The pain does not stop immediately; final recovery occurs after a month.
- Glycerin injections
They are carried out using a long thin needle, with which the doctor penetrates the area of the branching of the trigeminal nerve. Injections help well, but sometimes there are relapses of the disease at a later date.
New developments
The most modern and effective methods of treating trigeminal neuralgia can be called radiosurgery using Cyber Knife. This device uses a photon beam for treatment, which penetrates precisely into the area of inflammation and eliminates it. Treatment with CyberKnife provides high radiation dose accuracy, comfortable and fast healing. In addition, the procedure is absolutely safe for the patient.
Modern treatment using Cyber Knife can be considered the most effective. This technique is used not only abroad, but also in the vast expanses of the former USSR: in Russia, Ukraine, Belarus. For your information, treatment in Moscow will cost 180,000 rubles.
TICKET No. 1
1. A 68-year-old female patient complains of paroxysmal pain in the right half of her face, lasting for 1-2 minutes. The pain begins suddenly, spontaneously, or is provoked by touching the upper lip while washing, “radiating to the nose,” right eye, temple. During an attack - discharge from the nose, lacrimation. These complaints appeared 5 years ago. At first the attacks were rare - 1-2 times a week, now from 15 to 20 times a day. Periodically receives outpatient treatment from a neurologist.
External examination without any features. The skin is clean. Palpation of the temporomandibular joints is painless.
Make a diagnosis. Carry out differential diagnosis. Create a comprehensive treatment plan.
2. Perform primary surgical treatment of the facial wound (application of an interrupted and U-shaped suture).
Diagnosis:
Neuralgia of the 2nd branch of the trigeminal nerve.
Treatment Trigeminal neuralgia is performed by neurologists.
First of all, antiepileptic drugs are prescribed to relieve pain: tegre-
tol (finlepsin), ethosuxemide. morpholep, trimethin, clonazepam, etc.
Tegretol (Carbamazepine, Finlepsin) on the first day is prescribed 0.1 (0.2) grams 2 times
per day. Every day the dose is increased by 0.1 g. Adjusted to a maximum of 0.6-0.8 g per day (in 3-4 doses). The effect occurs 2-3 days from the start of treatment. After the pain disappears, the dose of the drug is reduced daily by 0.1 g and brought to 0.1-0.2 g per day. The course of treatment is 3-4 weeks. Before discharge from the hospital, the dose of the drug is reduced to the minimum dose at which attacks of pain do not appear.
Ethosumsimide (Suxilep, Ronton) is prescribed at a dose of 0.25 g per day. Gradually increase the dose to 0.5-1.0 g per day (in 3-4 doses), maintain the dose for several days and gradually
reduced to 0.25 g per day. Treatment lasts 3-4 weeks.
A course of treatment with nicotinic acid is being carried out. It is administered intravenously in the form of a 1% solution, starting with 1 ml (nicotinic acid is dissolved in 10 ml of a 40% glucose solution). Every day the dose is increased by 1 ml and brought to 10 ml (on the tenth day of treatment), and then reduced daily by 1 ml and ended with the introduction of 1 ml of the drug. It should be remembered that nicotinic acid must be administered slowly, after meals, in a lying position (since the drug reduces blood pressure).
Conservative treatment includes the appointment of B vitamins, antihistamines
drugs, biogenic stimulants (FIBS, aloe, biosed, peloidin or other antihypertensive and antispasmodic drugs.
According to indications, physiotherapy is prescribed (electrophoresis or phonophoresis with analgesic-
mi or anesthetics, diadynamic currents, ultraviolet irradiation, UHF, etc.). Surgical treatment of trigeminal neuralgia of central origin by a maxillofacial surgeon does not produce a positive effect.
A good effect in the early stages is achieved by blockades with low concentration anesthetics - 0.25-0.5% (trimecaine, lidocaine), which are carried out at the exit of the corresponding branches of the trigeminal nerve, a course of 15-20 injections. Effect after 1-2 weeks. For local blockade, anesthetic ointments are used - lidocaine, anesthetic.
Differential diagnosis: pulpitis, sinusitis, odontogenic plexalgia.
One of the differential diagnostic signs of trigeminal neuralgia is pain on palpation at the exit points of the branches of the trigeminal nerve, as well as the presence of “trigger” or “trigger” zones. During an exacerbation of the disease, even minor irritation of the trigger zone causes paroxysmal pain
In patients with neuralgia of the second branch, the trigger zones can be located in the nasolabial fold in the area of the wing of the nose, in the area of the corner of the mouth, on the alveolar processes of the jaws (on the affected side)
What may be needed from diagnostics:
1. MRI scan of the brain, facial tissue and/or neck. MRI scans clearly show the brain centers of the trigeminal nerve and its exit area (root), blood vessels, and paranasal sinuses.
2. X-ray computed tomography of the jaws and face. CT scans show bones, jaws and teeth, and sinuses in detail. RCT helps in diagnosing disorders of the structure of the bone canals of the branches of the trigeminal nerve.
3. Panoramic photographs of the upper and lower jaws (orthopantomogram) or targeted X-ray photographs of the teeth. Such radiographs allow us to judge the causes of damage to the jaw branches of the nerve. Cysts of the roots of the teeth are visible, the filling material extends beyond the apex of the tooth, and fractures of the roots of the teeth.
4. Blood tests for the presence of viral inflammation of the trigeminal nerve. Suspicion of the presence of a virus and weak immunity as the cause of its activity can be easily verified using a blood test.
5. Electromyography is a method for studying the conduction of impulses along nerves. This research method helps to establish the presence/absence and level of disturbance in the conduction of impulses along a nerve (cerebral cortex, brain stem or nerve branches)
2)PHO:- a surgical operation aimed at creating favorable conditions for wound healing, preventing and (or) combating wound infection; includes removal of non-viable and contaminated tissue from the wound, final stopping of bleeding, excision of necrotic edges and other measures.
Primary surgical treatment of the wound- the first wound treatment for this patient.
Secondary surgical treatment of the wound- treatment carried out for secondary indications, i.e. regarding subsequent changes caused by the development of infection.
Early surgical treatment of the wound- performed in the first 24 hours after injury.
Primary delayed surgical debridement- primary surgical treatment, carried out on the second day after injury, i.e. in 24-48 hours.
Late surgical debridement- carried out after 48 hours or more.
Features of surgical treatment of wounds in the maxillofacial area:
Must be carried out in full in the most early dates;
The edges of the wound cannot be excised (freshened), but only non-viable (necrotic) tissue should be removed;
Wounds penetrating into the oral cavity must be isolated from the oral cavity by applying blind sutures to the mucous membrane, followed by layer-by-layer suturing (muscles, skin);
If the lips are wounded, the red border (Cupid's line) should first be matched and sewn together, and then the wound should be sutured;
Foreign bodies in the wound must be removed; the only exceptions are foreign bodies that are located in hard-to-reach places (wing - palatine fossa, etc.), because searching for them is associated with additional trauma;
When the eyelids or red border of the lips are injured, in order to avoid further tension along the suture line, in some cases, the skin and mucous membrane must be mobilized to prevent retraction (contraction) of the tissue. Sometimes it is necessary to move opposing triangular flaps;
If the parenchyma of the salivary glands is injured, it is necessary to sew together the capsule of the gland, and then all subsequent layers; if the duct is damaged, sew it together or create a false duct;
The wounds are closed with a blind stitch; wounds are drained only when they become infected (late surgical treatment);
In cases of severe swelling and wide separation of the edges of the wound, U-shaped sutures are used to prevent the cutting of sutures (for example: on gauze rolls, 1.0-1.5 cm away from the edges of the wound);
In the presence of large through defects of soft tissues in the cheek area, in order to avoid cicatricial contracture of the jaws, surgical treatment is completed by suturing the skin to the oral mucosa, which creates favorable conditions for subsequent plastic closure of the defect, and also prevents the formation of rough scars and deformation of nearby tissues;
Postoperative wound management is often carried out using the open method, i.e. without applying bandages on the second and subsequent days of treatment;
In order to prevent suture line divergence, one should not strive to remove them early.
1. Surgical treatment of wounds is carried out after hygienic treatment of the skin around the wound (with antiseptic agents).
2. The hair around the wound is shaved, if necessary.
3. The wound is again treated with antiseptic drugs to remove foreign bodies and pollution.
4. Local anesthesia and hemostasis are performed.
5. Non-viable tissues are excised.
6. The wound is sutured in layers by applying a primary blind suture.
7. The suture line is treated with a solution of iodine or brilliant green.
8. Apply an aseptic dressing.
9. The first dressing is done the next day after the operation.
10. It is advisable to treat the wound without a bandage ( open method). Only when wounds become infected or have hematomas should bandages be applied (regular or pressure).
11. When the inflammatory process develops in the wound, the abscesses are opened and drained, and drug treatment is prescribed (antibiotics, etc.).
), Candidate of Medical Sciences, Associate Professor of the Department of Maxillofacial Surgery and Surgical Dentistry of KSMA, Assistant Head. department of educational work. Awarded the medal "Excellence in Dentistry" in 2016.
Fortunately, few people are familiar with the pain that occurs with trigeminal neuralgia. Many doctors consider it one of the strongest a person can experience. The intensity of the pain syndrome is due to the fact that the trigeminal nerve provides sensitivity to most facial structures.
The trigeminal is the fifth and largest pair of cranial nerves. It belongs to the nerves of a mixed type, having motor and sensory fibers. Its name is due to the fact that the nerve is divided into three branches: orbital, maxillary and mandibular. They provide sensitivity to the face, soft tissues of the cranial vault, dura mater, oral and nasal mucosa, and teeth. The motor part provides nerves (innervates) some muscles of the head.
The trigeminal nerve has two motor nuclei and two sensory ones. Three of them are located in the hindbrain, and one is sensitive in the middle. The motor ones form the motor root of the entire nerve at the exit from the pons. Next to the motor fibers, they enter the medulla, forming a sensory root.
These roots form the nerve trunk, penetrating under the dura mater. Near the apex of the temporal bone, the fibers form the trigeminal ganglion, from which three branches emerge. The motor fibers do not enter the ganglion, but pass under it and connect with the mandibular branch. It turns out that the ophthalmic and maxillary branches are sensory, and the mandibular branch is mixed, since it includes both sensory and motor fibers.
Branch functions
- Ophthalmic branch. Transmits information from the scalp, forehead, eyelids, nose (excluding nostrils), and frontal sinuses. Provides sensitivity to the conjunctiva and cornea.
- Maxillary branch. Infraorbital, pterygopalatine and zygomatic nerves, branches of the lower eyelid and lips, sockets (posterior, anterior and middle), innervating the teeth on the upper jaw.
- Mandibular branch. Medial pterygoid, auriculotemporal, inferior alveolar and lingual nerves. These fibers transmit information from the lower lip, teeth and gums, chin and jaw (except at a certain angle), part of the outer ear and the oral cavity. Motor fibers provide communication with the masticatory muscles, giving a person the ability to speak and eat. It should be noted that the mandibular nerve is not responsible for taste perception; this is the task of the chorda tympani or the parasympathetic root of the submandibular ganglion.
Pathologies of the trigeminal nerve are expressed in disruption of the functioning of certain motor or sensory systems. The most common type is trigeminal or trigeminal neuralgia - inflammation, compression or pinching of fibers. In other words, this is a functional pathology of the peripheral nervous system, which is characterized by attacks of pain in half of the face.
Neuralgia of the facial nerve is predominantly an “adult” disease; it is extremely rare in children.
Attacks of facial neuralgia are marked by pain, which is conventionally considered one of the most severe pain that a person can experience. Many patients compare it to a lightning strike. Attacks can last from a few seconds to hours. However, severe pain is more typical for cases of inflammation of the nerve, that is, for neuritis, and not for neuralgia.
Causes of trigeminal neuralgia
The most common cause is compression of the nerve itself or a peripheral node (ganglion). Most often, the nerve is compressed by the pathologically tortuous superior cerebellar artery: in the area where the nerve leaves the brain stem, it passes close to blood vessels. This reason often causes neuralgia in the case of hereditary defects of the vascular wall and the presence of an arterial aneurysm, in combination with high blood pressure. For this reason, neuralgia often occurs in pregnant women, and after childbirth the attacks go away.
Another cause of neuralgia is a defect in the myelin sheath. The condition can develop with demyelinating diseases (multiple sclerosis, acute disseminated encephalomyelitis, Devic's opticomyelitis). In this case, neuralgia is secondary, since it indicates a more severe pathology.
Sometimes compression occurs due to the development of a benign or malignant tumor of the nerve or meninges. Thus, in neurofibromatosis, fibroids grow and cause various symptoms, including neuralgia.
Neuralgia can be a consequence of brain contusion, severe concussion, or prolonged fainting. In this condition, cysts arise that can compress tissue.
Rarely, the cause of the disease is postherpetic neuralgia. Along the course of the nerve, characteristic blistering rashes appear and burning pain occurs. These symptoms indicate damage to the nervous tissue by the herpes simplex virus.
Causes of attacks with neuralgia
When a person has neuralgia, it is not necessary that the pain is constant. Seizures develop as a result of irritation of the trigeminal nerve in trigger or “trigger” areas (corners of the nose, eyes, nasolabial folds). Even with a weak impact, they generate a painful impulse.
Risk factors:
- Shaving. An experienced doctor can determine the presence of neuralgia by the patient’s thick beard.
- Stroking. Many patients refuse napkins, scarves and even makeup, protecting their face from unnecessary exposure.
- Brushing teeth, chewing food. Movement of the muscles of the mouth, cheeks, and pharyngeal constrictors causes the skin to shift.
- Taking fluids. In patients with neuralgia, this process causes the most severe pain.
- Crying, laughing, smiling, talking and other actions that provoke movement in the structures of the head.
Any movement of the facial muscles and skin can cause an attack. Even a breath of wind or a transition from cold to heat can provoke pain.
Symptoms of neuralgia
Patients compare pain due to trigeminal nerve pathology to a lightning bolt or powerful electric shock, which can cause loss of consciousness, tearing, numbness and dilated pupils. The pain syndrome covers one half of the face, but the entirety: skin, cheeks, lips, teeth, orbits. However, the frontal branches of the nerve are rarely affected.
For this type of neuralgia, pain irradiation is not typical. Only the face is affected, with no sensation spreading to the arm, tongue or ears. It is noteworthy that neuralgia affects only one side of the face. As a rule, attacks last a few seconds, but their frequency may vary. The resting state (“light interval”) usually lasts days and weeks.
Clinical picture
- Severe pain that has a piercing, through or shooting nature. Only one half of the face is affected.
- Distortion of individual areas or the entire half of the face. Distortion of facial expressions.
- Muscle twitching.
- Hyperthermic reaction (moderate increase in temperature).
- Chills, weakness, pain in the muscles.
- Small rash in the affected area.
The main manifestation of the disease, of course, is severe pain. After an attack, distortions in facial expression are noted. With advanced neuralgia, changes can be permanent.
Similar symptoms can be observed with tendinitis, occipital neuralgia and Ernest's syndrome, so it is important to carry out a differential diagnosis. Temporal tendonitis causes pain in the cheeks and teeth, and discomfort in the neck.
Ernest syndrome is damage to the stylomandibular ligament, which connects the base of the skull and the lower jaw. The syndrome causes pain in the head, face and neck. With occipital neuralgia, pain is localized in the back of the head and moves to the face.
Nature of pain
- Typical. Shooting sensations resembling electric shocks. As a rule, they occur in response to touching certain areas. Typical pain occurs in attacks.
- Atypical. Constant pain that covers most of the face. There are no decay periods. Atypical pain due to neuralgia is more difficult to cure.
Neuralgia is a cyclical disease: periods of exacerbation alternate with subsidence. Depending on the degree and nature of the lesion, these periods have different durations. Some patients experience pain once a day, while others complain of attacks every hour. However, for everyone, the pain begins abruptly, reaching its peak within 20-25 seconds.
Toothache
The trigeminal nerve consists of three branches, two of which provide sensation to the oral area, including the teeth. All unpleasant sensations are transmitted by the branches of the trigeminal nerve to one side of the face: reaction to cold and hot, pain of different types. It is not uncommon for people with trigeminal neuralgia to go to the dentist, mistaking the pain for a toothache. However, rarely do patients with pathologies of the dental system come to a neurologist with suspected neuralgia.
How to distinguish toothache from neuralgia:
- When a nerve is damaged, the pain is similar to an electric shock. The attacks are mostly short, and the intervals between them are long. There is no discomfort in between.
- Toothache, as a rule, does not begin and end suddenly.
- The intensity of pain during neuralgia makes a person freeze, and the pupils dilate.
- Toothache can begin at any time of the day, and neuralgia manifests itself exclusively during the day.
- Analgesics help relieve toothache, but they are practically ineffective for neuralgia.
It is easy to distinguish toothache from inflammation or a pinched nerve. Toothache most often has a wave-like course, the patient is able to indicate the source of the impulse. There is an increase in discomfort when chewing. The doctor can take a panoramic photo of the jaw, which will reveal dental pathologies.
Odontogenic (tooth) pain occurs many times more often than manifestations of neuralgia. This is due to the fact that pathologies of the dental system are more common.
Diagnostics
With severe symptoms, making a diagnosis is not difficult. The main task of the doctor is to find the source of neuralgia. Differential diagnosis should be aimed at excluding oncology or another cause of compression. In this case, they talk about a true condition, not a symptomatic one.
Examination methods:
- High-resolution MRI (magnetic field strength greater than 1.5 Tesla);
- computed angiography with contrast.
Conservative treatment of neuralgia
Conservative and surgical treatment of the trigeminal nerve is possible. Almost always, conservative treatment is first used, and if it is ineffective, surgery is prescribed. Patients with this diagnosis are entitled to sick leave.
Drugs for treatment:
- Anticonvulsants (anticonvulsants). They are able to eliminate congestive excitation in neurons, which is similar to a convulsive discharge in the cerebral cortex during epilepsy. For these purposes, drugs with carbamazepine (Tegretol, Finlepsin) are prescribed at 200 mg per day with the dose increasing to 1200 mg.
- Centrally acting muscle relaxants. These are Mydocalm, Baclofen, Sirdalud, which eliminate muscle tension and spasms in neurons. Muscle relaxants relax the trigger zones.
- Analgesics for neuropathic pain. They are used if there is burning pain caused by a herpetic infection.
Physiotherapy for trigeminal neuralgia can relieve pain by increasing tissue nutrition and blood supply to the affected area. Thanks to this, accelerated nerve recovery occurs.
Physiotherapy for neuralgia:
- UHF (ultra-high frequency therapy) improves microcirculation to prevent atrophy of the masticatory muscles;
- UVR (ultraviolet irradiation) helps relieve pain due to nerve damage;
- electrophoresis with novocaine, diphenhydramine or platyphylline relaxes the muscles, and the use of B vitamins improves the nutrition of the myelin sheath of the nerves;
- laser therapy stops the passage of impulses through the fibers, relieving pain;
- electric currents (impulsive mode) can increase remission.
It should be remembered that antibiotics are not prescribed for neuralgia, and taking conventional painkillers does not have a significant effect. If conservative treatment does not help and the intervals between attacks become shorter, surgical intervention is required.
Massage for facial neuralgia
Massage for neuralgia helps eliminate muscle tension and increase tone in atonic (weakened) muscles. In this way, it is possible to improve microcirculation and blood supply in the affected tissues and directly in the nerve.
Massage involves influencing the exit areas of nerve branches. These are the face, ears and neck, then the skin and muscles. The massage should be carried out in a sitting position, leaning your head back on the headrest and allowing the muscles to relax.
You should start with light massaging movements. It is necessary to focus on the sternocleidomastoid muscle (on the sides of the neck), then move up to the parotid areas. Here the movements should be stroking and rubbing.
The face should be massaged gently, first on the healthy side, then on the affected side. The duration of the massage is 15 minutes. The optimal number of sessions per course is 10-14.
Surgery
As a rule, patients with trigeminal nerve pathology are offered surgery after 3-4 months of unsuccessful conservative treatment. Surgical intervention may involve eliminating the cause or reducing the conduction of impulses along the branches of the nerve.
Operations that eliminate the cause of neuralgia:
- removal of tumors from the brain;
- microvascular decompression (removal or displacement of vessels that have dilated and put pressure on the nerve);
- expansion of the exit of the nerve from the skull (the operation is performed on the bones of the infraorbital canal without aggressive intervention).
Operations to reduce the conductivity of pain impulses:
- radiofrequency destruction (destruction of altered nerve roots);
- rhizotomy (dissection of fibers using electrocoagulation);
- balloon compression (compression of the trigeminal ganglion with subsequent death of fibers).
The choice of method will depend on many factors, but if the operation is chosen correctly, attacks of neuralgia will stop. The doctor must take into account the patient’s general condition, the presence of concomitant pathologies, and the causes of the disease.
Surgical techniques
- Blockade of certain sections of the nerve. A similar procedure is prescribed in the presence of severe concomitant pathologies in old age. The blockade is carried out using novocaine or alcohol, providing an effect for about a year.
- Ganglion block. The doctor gains access to the base of the temporal bone, where the Gasserian node is located, through a puncture. Glycerol is injected into the ganglion (glycerol percutaneous rhizotomy).
- Transection of the trigeminal nerve root. This is a traumatic method, which is considered radical in the treatment of neuralgia. To implement it, extensive access to the cranial cavity is required, so trepanation is performed and burr holes are applied. At the moment, the operation is performed extremely rarely.
- Dissection of the bundles that lead to the sensory nucleus in the medulla oblongata. The operation is performed if the pain is localized in the projection of the Zelder zones or distributed according to the nuclear type.
- Decompression of the Gasserian node (Janetta operation). The operation is prescribed when a nerve is compressed by a vessel. The doctor separates the vessel and the ganglion, isolating it with a muscle flap or synthetic sponge. Such an intervention relieves the patient of pain for a short period of time, without depriving him of sensitivity or destroying nerve structures.
It must be remembered that most operations for neuralgia deprive the affected side of the face of sensitivity. This causes inconvenience in the future: you can bite your cheek and not feel pain from injury or damage to the tooth. Patients who have undergone such surgery are advised to visit the dentist regularly.
Gamma knife and particle accelerator in treatment
Modern medicine offers patients with trigeminal neuralgia minimally invasive, and therefore atraumatic, neurosurgical operations. They are carried out using a particle accelerator and a gamma knife. They are relatively recently known in the CIS countries, and therefore the cost of such treatment is quite high.
The doctor directs beams of accelerated particles from ring sources to a specific area of the brain. The cobalt-60 isotope emits a beam of accelerated particles, which burns out the pathogenic structure. The processing accuracy reaches 0.5 mm, and the rehabilitation period is minimal. Immediately after the operation, the patient can go home.
Traditional methods
There is an opinion that you can relieve pain from trigeminal neuralgia with the help of black radish juice. The same remedy is effective for sciatica and intercostal neuralgia. It is necessary to moisten a cotton swab with juice and gently rub it into the affected areas along the nerve.
Another effective remedy is fir oil. It not only relieves pain, but also helps restore the nerve in case of neuralgia. It is necessary to moisten a cotton wool with oil and rub along the length of the nerve. Since the oil is concentrated, do not use it vigorously, otherwise you may burn. You can repeat the procedure 6 times a day. The course of treatment is three days.
For neuralgia, fresh geranium leaves are applied to the affected areas for several hours. Repeat twice a day.
Treatment regimen for a cold trigeminal nerve:
- Warming your feet before bed.
- Take vitamin B tablets and a teaspoon of beebread twice a day.
- Apply Vietnamese “Star” to the affected areas twice a day.
- Drink hot tea with soothing herbs (motherwort, lemon balm, chamomile) at night.
- Sleeping in a hat with rabbit fur.
When pain affects teeth and gums, you can use chamomile infusion. Infuse a teaspoon of chamomile in a glass of boiling water for 10 minutes, then strain. You need to take the tincture into your mouth and rinse until it cools. You can repeat the procedure several times a day.
Tinctures
- Hop cones. Pour vodka (1:4) over the raw material, leave for 14 days, shake daily. Drink 10 drops twice a day after meals. Must be diluted with water. To normalize sleep and calm the nervous system, you can stuff your pillow with hop cones.
- Garlic oil. This product can be purchased at a pharmacy. So as not to lose essential oils, you need to make an alcohol tincture: add a teaspoon of oil to a glass of vodka and wipe the whiskey with the resulting mixture twice a day. Continue the course of treatment until the attacks disappear.
- Marshmallow root. To prepare the medicine, you need to add 4 teaspoons of the raw material to a glass of cooled boiled water. The product is left for a day, in the evening gauze is soaked in it and applied to the affected areas. The top of the gauze is covered with cellophane and a warm scarf. You need to keep the compress for 1-2 hours, then wrap your face with a scarf overnight. Usually the pain stops after a week of treatment.
- Duckweed. This remedy is suitable for relieving puffiness. To prepare duckweed tincture, you need to prepare it in the summer. Add a spoonful of raw materials to a glass of vodka and leave for a week in a dark place. The product is filtered several times. Take 20 drops mixed with 50 ml of water three times a day until complete recovery.
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