Diagnosis
The pain, sensitivity and temperature sensation in the facial area are differentiated more precisely by recording the patient’s medical history (anamnesis) and by palpation of the pressure points or Sölder lines. When taking the medical history, the main focus is on the pain characteristics and possible triggers. A subsequent neurological examination serves to exclude possible underlying neurological diseases as the cause of the pain.
If the nerve or one of its branches is damaged directly “far from the center” (peripheral trigeminal lesion), (punctual) (pressure) pain occurs at the respective exit points, as well as during chewing and speaking (due to the chewing muscles innervated by the nerve). In the affected area, the mimic muscles are often tensed (involuntarily) during the pain attack or begin to “tremble” (tonic or clonic). After the pain attack, no new pain attack can be triggered for seconds or minutes (refractory time).
If damage to the trigeminal nerve is the central cause, pain, sensitivity and temperature perception disorders occur in the area of the so-called Sölder lines. Depending on the nucleus in which the damage is present (nucleus mesencephalicus n. trigemini, nucleus pricipalis n. trigemini and nucleus spinalis n. trigemini), the above-mentioned disorders occur in its supply area, corresponding to the Sölder lines. In order to exclude spatial claims in the skull, X-ray and CT images of the head can be taken.
As differential diagnoses, injuries of the trigeminal nerve after accidents or operations can be considered in addition to other forms of headache. Facial pain can also be caused by multiple sclerosis, herpes zoster, psychosomatic pain or calcification of the temporal artery. This topic could also be of interest to you: Duration of an inflammation of the nervesWhen the fifth cranial nerve fails, usually in the course of inflammation, nerve pain of this nerve can occur (trigeminal neuralgia).
Leading symptoms are suddenly shooting, most violent face pain, which often occurs on one side in the supply area of one or more branches of the trigeminal nerve (V1: N. ophthalmicus, V2: N. maxillaris, V3: N. mandibularis) and can be accompanied by running tears as well as redness and sweating of the skin in the affected area. The nerve pain (neuralgia) lasts for a few seconds, the attacks may occur several times a day for weeks or months, but painless episodes occur repeatedly.The pain can occur spontaneously or as a result of triggers. Such triggers include facial movements, chewing, brushing teeth, speaking or a cold breeze. On a scale, the intensity of the pain is usually classified by those affected as the highest possible, and trigeminal neuralgia is one of the most painful diseases of all. Due to this fact, many patients develop depressive moods and the suicide rate among those affected is increased.
