Diagnosis
Not always, when strong pain in the face occurs when touching or chewing and speaking, an inflammation of the trigeminal nerve must be the cause. For this reason, the diagnosis of an inflammation of the trigeminal nerve should always be based on several criteria. Other conditions that may be considered for similar symptoms include cluster headaches, so-called idiopathic facial pain, inflammation or injury of the teeth, eyes or sinuses, and jaw problems.
In order to be able to distinguish these diseases from a real trigeminal neuralgia, a detailed patient interview is first held in which the attending physician asks the acute symptoms in detail and tries to exclude other diseases by asking specific questions.Diagnostically, trigeminal neuralgia can also be divided into two forms. For this reason, an imaging method is usually used – magnetic resonance imaging (MRI). With the help of the images produced by MRI, the cause of the neuralgia can be identified and, if possible, a suitable therapy can be initiated.
A distinction is made between the so-called classic trigeminal neuralgia, in which an unusual course of a blood vessel presses on the trigeminal nerve and thus causes the pain, and the so-called symptomatic trigeminal neuralgia, in which another disease is the cause of the symptoms. Multiple sclerosis of tumors in the brain stem is the main cause. This differentiation is also diagnostically important, since the therapy depends crucially on the respective cause.
Causes
A distinction is made between classic or idiopathic trigeminal neuralgia and symptomatic trigeminal neuralgia. The difference is that in a symptomatic form, another disease is the cause of the existing symptomatology. The cause in the classic or idiopathic form is an unusual course of a blood vessel that destroys the nerve’s insulation, the myelin sheath, causing the nerve to become hypersensitive.
Symptomatic trigeminal neuralgia can be caused by various diseases. Particularly common are a lack of nerve sheathing (destroyed myelin sheath), e.g. in the context of multiple sclerosis, or insufficient blood supply to a nerve part of the trigeminal nerve, as can happen in a stroke. Benign, extensive tumors in the inner ear canal (acoustic neuroma) can also be the cause.
In the case of a cold, the causative pathogens are often also located in the area of the paranasal sinuses in the face. From here they can spread in different directions. Due to the spatial proximity, they can also spread in the direction of the trigeminal nerve.
This can cause pain in the trigeminal nerve area even days after a cold has subsided. Although this is unusual, it can occur occasionally. After a cold, the human body is often weakened.
This means that the immune system is busy and therefore the body is more susceptible and can develop various symptoms faster. Therefore, a temporary pain in the area of the trigeminal nerve does not have to be immediately attributed to an inflammation. Occasionally, however, the pathogens that cause the common cold are very persistent and cause a pronounced inflammation of the nerve.
If the pain does not improve within several weeks or even gets worse, a doctor should be consulted. The term herpes virus describes a group of viruses that they permanently settle in certain nerve cells in the body and can be reactivated by certain triggering factors such as stress or immune deficiency. The manifestations range from simple herpes blisters on the lip to pronounced shingles (herpes zoster).
The viruses always spread via the affected nerves, which can lead to an inflammation with typical symptoms on the skin. If this affects the trigeminal nerve, this leads to trigeminal inflammation, which is often accompanied by very severe pain. The focus of therapy here is primarily on pain therapy and treatment with antiviral agents (e.g. Aciclovir) to contain the herpes virus.
Unfortunately, a complete removal of herpes viruses from the body is not possible. Various diseases of the teeth can also be a possible cause of trigeminal inflammation. The second and third branches of the trigeminal nerve also supply the teeth. Therefore, infections that have started at the teeth can spread towards the nerve and lead to an inflammation there. Even small injuries to the trigeminal nerve itself, for example through a dental invasive procedure, can promote inflammation.