Trigeminal neuralgia is chronic pain caused by disorders of the trigeminal nervefifth paragraph of twelve pairs of nerves originating from the brain (cranial nerves). This pain usually appears on only one side of the face and is most common in the lower face and jaw.
The trigeminal nerve is located on each side of the face. This nerve allows a person to feel various sensations on the face. However, in trigeminal neuralgia, the nerve is disturbed, so the patient can feel pain without any stimulation. Pain that feels stabbing or like an electric shock.
Trigeminal neuralgia occurs suddenly and lasts from a few seconds to about 2 minutes. These attacks of pain can occur every day for a few days to several months. In severe cases, trigeminal neuralgia occurs hundreds of times a day.
Causes of Trigeminal Neuralgia
Trigeminal neuralgia can be caused by several factors, namely:
- Having impaired nerve function due to nerves being compressed by dilated blood vessels or surrounding tumors
- Have an injury to the trigeminal nerve, for example from trauma to the face or the effects of surgery
- Suffering from conditions that can damage the protective membranes of the nerves (myelin), such as diseases multiple sclerosis
Trigeminal neuralgia risk factors
Trigeminal neuralgia can happen to anyone. However, a person with the following conditions is more at risk for trigeminal neuralgia:
- Female gender
- Over 50 years old
- Have a family history of trigeminal neuralgia
- Suffering from high blood pressure (hypertension)
Symptoms of Trigeminal Neuralgia
Trigeminal neuralgia is characterized by pain. The pain feels like being stabbed by a sharp object or electrocuted. These attacks of pain usually last from a few seconds to 2 minutes. After an attack of severe pain, the patient may also feel a burning and throbbing pain.
Generally, pain occurs in the cheeks, jaw, gums, teeth, lips, and sometimes the eyes and forehead. Pain can come on suddenly or be triggered by certain movements, such as:
- Speak
- Smile
- Chew
- Brushing teeth
- Wash face
- Shave
In addition to movement, pain in trigeminal neuralgia can also be triggered by vibrations, such as when driving or the wind blowing on your face. Usually, the pain only appears on one side of the face, but it is possible that the pain can appear on both sides.
Trigeminal neuralgia pain can occur every day, for days or maybe months. However, some people may experience periods of remission, which are periods when the pain doesn't come on for months or years.
When to go to the doctor
See your doctor right away if you have persistent facial pain, especially if your symptoms do not improve after taking pain relievers, such as ibuprofen or paracetamol.
Cavities or dental infections can also cause severe pain such as trigeminal neuralgia. Therefore, you need to make sure to see a dentist whether the pain you feel is caused by a dental problem or not.
Diagnosis of Trigeminal Neuralgia
To diagnose trigeminal neuralgia, the doctor will ask questions about the characteristics of pain and what triggers it. The doctor will also ask about the patient's past medical history and family medical history.
After that, the doctor will perform a physical examination. The doctor may perform an examination of the face to determine which part is experiencing pain and which branch of the trigeminal nerve is affected.
Doctors can also perform investigations, such as an MRI of the head, to determine the cause of trigeminal neuralgia
Trigeminal Neuralgia Treatment
Once the patient is diagnosed with trigeminal neuralgia, the doctor will prescribe treatment based on the condition and its cause. The goal of trigeminal neuralgia treatment is to relieve the patient's pain. Some of the treatments that can be done include:
Drugs
As a first treatment, the doctor can give some of the following medicines:
- Anticonvulsants, such as carbamazepine, oxcarbazepine, lamotrigine, phenytoin, clonazepam, or gabapentin, to slow down nerve impulses thereby reducing the ability of nerves to transmit pain to the brain
- Antispasmodic drugs, such as baclofen, to relax muscles
- Tricyclic antidepressants, such as amytriptyline, to block pain signals sent to the brain
- Botox injections or botulinum toxin, to reduce pain that cannot be overcome with medication
Operation
Surgery is performed if symptoms do not subside or side effects arise from continuous drug consumption. The following are some types of surgery that can be done to treat trigeminal neuralgia:
- Microvascular decompression (microvascular decompression)This operation is performed by moving or removing blood vessels adjacent to the trigeminal nerve. The blood vessels will be kept away with the trigeminal nerve, then the doctor will provide a soft pad between the two. In certain cases, the doctor may also cut some of the nerves that are pressing on the trigeminal nerve.
- Gamma knife radiation surgery (gamma knife radiosurgery)This procedure involves exposing a certain dose of radiation to the trigeminal nerve root to damage it, thereby reducing pain. This procedure can be repeated if the pain returns.
- RhizotomyThis procedure aims to damage the nerve fibers to block pain. This can be achieved by injecting sterile glycerol (glycerol injection), pressing the nerve using a balloon (balloon compression), or conduct electricity and heat (radiofrequency thermal lesioning) in the trigeminal nerve root.
Although it can relieve pain, the three procedures above have the risk of causing facial numbness or numbness, bleeding and bruising on the face, eye and hearing problems on the side of the procedure, or even a stroke.
Complications of Trigeminal Neuralgia
Trigeminal neuralgia that is not treated properly will get worse and can make it difficult for sufferers to carry out normal activities. This can have an impact on the sufferer's mental health and can trigger psychiatric problems, such as:
- Depression
- Anxiety disorders
- Sleep disturbance
In severe conditions, sufferers can even think about suicide because they can't stand the pain they feel.
Prevention of Trigeminal Neuralgia
Trigeminal neuralgia is difficult to prevent. The best effort that can be done is to avoid the factors that trigger the occurrence of pain attacks, for example by:
- Wash your face with warm water, which is neither too cold nor too hot
- Consuming food or drink with normal temperature
- Eating soft or not too hard food
- Avoid drinks that are too acidic
- Clean your mouth after eating
- Brush your teeth carefully, and use a soft toothbrush