Trigeminal neuralgia is a nerve disorder causes facial pain. Trigeminal neuralgia is the most frequently occurring of all the nerve pain disorders.
Trigeminal neuralgia pain comes and goes, like bursts of sharp, stabbing, electric-shocks. This pain can last from a few seconds to a few minutes.
Trigeminal nerve is the fifth and largest cranial nerve having three branches – Ophthalmic nerve, Maxillary nerve and Mandibular nerve.
Trigeminal nerve supplies skin and mucous membrane of head and muscles of jaw. It transmits sensations from cornea of eye, tympanic membrane of ear, skin of the face, anterior two third of the tongue, mucous membrane of mouth, cheek and throat.
Ophthalmic nerve carries sensation to brain from eye, upper eyelids and forehead
Maxillary nerve carries sensations from lower eyelid, nose, cheek and upper lip
Mandibular nerve carries sensations from lower lip, jaw and mucous membrane of mouth and throat. It also helps in actions like biting, chewing, and swallowing.
Trigeminal neuralgia most frequently affects women older than 50 years.
It can affect individuals of all the races.
• Most commonly the pain involves the lower face and jaw, but it may appear near the nose, ears, eyes or lips.
• Trigeminal neuralgia may be caused by multiple sclerosis
• The underlying pathology of trigeminal neuralgia is the demyelination (erosion of the nerve sheath) of the sensory nerve fibers of the Trigeminal Nerve.
• Pain of Trigeminal neuralgia may be caused by trigger factors such as – Shaving, brushing teeth, talking, chewing and drinking
• A blood vessel pressing on the trigeminal nerve
• Tongue piercing
• Post viral, bacterial infections like herpes
• Disorders like multiple sclerosis that damage the myelin sheath (nerve covering which serves as an insulator)
• Compression of the nerve by a tumor or cyst
• Habitual intoxication from alcohol, lead and other drugs
• Episodes of mild pain
• Periodic episodes of severe, shooting or stabbing pain that may feel like an electric shock
• Pain or attacks triggered by activities such as washing the face, chewing, smiling or brushing teeth
• Pain lasts for few seconds to a few minutes
• Washing your face, brushing your teeth, shaving, or talking
• Violent pain in face (cheek, jaw, eyes) nose and throat
• Pain radiates over the face
• Recurrent bouts of attacks even with mild trigger
• Anxiety, tension, restlessness and sleeplessness with fear of pain
• Dryness of mouth due to lowered secretion of saliva
• Dryness or irritation or ulcers of eyes due to lowered lachrymal secretions
• Physical examination, Physical findings in people with trigeminal neuralgia are normal.
• There is no specific investigation to diagnose trigeminal neuralgia.
• Neurological examination
• CT scan / MRI
• Routine blood test
• Electromyography, Nerve conduction velocity test
• Muscle relaxants
• Tri cyclic antidepressants
Prognosis of the Trigeminal neuralgia varies depending upon the underlying cause. In case if there is unknown cause treatment can provide some relief to the patient.
•Mental and physical sluggishness
•Disability to perform day to day activity
• Abnormal eye movements
•Left sided neuralgia with one cheek red, hot swollen
•Tingling and numbness with lower jaw pain and general restlessness
•Facial pain worse in a warm room, from lying on affected side and from draft of cold wind
•Facial pains sudden and violent
•Face bluish red, swollen, shining with upper lip swelling and twitching of muscles
•Pain worse from touch, lying down and in afternoon
•Marked right sided neuralgic pains extending behind the right ear
•Pain occurs in unbearable paroxysms, lightening like pains, drivig the patient to frenzy
•Pains cramping, shooting, spasmodic, sharp, cutting, stabbing, that comes and goes suddenly
•Pain worse from slight mental exertion, from washing face, from cold water, cold wind and from touch
•Neuralgic pains relieved by warmth
•Neuralgic pains with alternate sides
•Pains tearing, shifting rapidly, extending to teeth and head on affected side
•Restlessness with pain, keeps changing positions
•Patient cries with pain and is always chilly, yet desires and feels better in open air, from cold food and cold applications
•Pains worse in warm room
•Mouth extremely dry and frequently lick due to dryness of lips but with no thirst
•Stabbing pains which makes patient shudder
•Pains come suddenly and go suddenly
•Violent tearing, burning, jerking pains with sensitivity to touch.
• Avoiding any physical & mental stress and tension
• Avoiding triggers
• Avoiding direct air flow in face while travelling or sleeping
• Avoid cold exposures or temperatures and cold bath
• Avoid alcohol, caffeine
• Avoiding sudden jerky movements
• Maintaining a good oral hygiene
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