Medical history (history of illness) represents an important component in the diagnosis of trigeminal neuralgia. Family history Social history Current anamnesis/systemic anamnesis (somatic and psychological complaints). Do you experience headaches on one side of the head or both sides? How severe is the headache? Does the pain radiate? How long does the headache last and … Trigeminal Neuralgia: Medical History
Respiratory System (J00-J99) Sinusitis (inflammation of the paranasal sinuses). Eyes and eye appendages (H00-H59). Glaucoma (intraocular pressure elevation). Cardiovascular system (I00-I99) Aneurysm (vascular dilatation) of cerebral vessels. Apoplexy (stroke) Arteriovenous malformations (AVM) – congenital malformation of blood vessels in which the arteries are directly connected to the veins; these occur mainly in the CNS and … Trigeminal Neuralgia: Or something else? Differential Diagnosis
Pathogenesis (development of disease) The pathogenesis of trigeminal neuralgia is probably compression or damage to the nerve before it enters the bridge. Most commonly, it is a compression caused by the superior cerebellar artery (approximately 80% of cases; less commonly, the inferior anterior cerebellar artery or a dilated basilar artery). Etiologically (causally), trigeminal neuralgia is … Trigeminal Neuralgia: Causes
General measures Avoidance of long stays in the cold Avoidance of environmental pollution: Heavy metal intoxications Conventional non-surgical therapy methods Radiofrequency thermocoagulation – Pain fibers in the Gasserian ganglion are thermally eliminated (70-75 °C for 90 s) by a radiofrequency probe inserted through a horizontal cannula.The Gasserian ganglion is the ganglion (nerve node) where the … Trigeminal Neuralgia: Therapy
The following are the most important diseases or complications that may be contributed to by trigeminal neuralgia: Psyche – Nervous System (F00-F99; G00-G99). Anxiety Depression Pain relapse
The following forms of trigeminal neuralgia are distinguished: Idiopathic trigeminal neuralgia without evidence of vascular nerve compression – more common form; occurs predominantly unilaterally Classic trigeminal neuralgia with evidence of vascular nerve compression. Secondary (symptomatic) trigeminal neuralgia – a cause (e.g., multiple sclerosis (MS), space-occupying lesion in the cerebellopontine angle) may be found; rare form; … Trigeminal Neuralgia: Classification
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin and mucous membranes [perspiration]. Head [tic douloudeux – contractions (tightening) of facial muscles, redness of face] Eyes [lacrimation] Ophthalmic examination – including tonometry (measurement of intraocular pressure) [due … Trigeminal Neuralgia: Examination
1st order laboratory parameters – obligatory laboratory tests. Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate).
Therapeutic target Avoidance of attacks Therapy recommendations Therapy of the attack is possible only by prophylaxis (prevention) because of its short duration. Carbamazepine (first-line agent; antiepileptic); if carbamazepine/oxcarbazepine (the latter as an alternative to carbamazepine; off-label use) is not tolerated or is not sufficiently effective, the antiepileptic agents pregabalin or gabapentin can be added. Therapy … Trigeminal Neuralgia: Drug Therapy
Obligatory medical device diagnostics. Magnetic resonance imaging of the skull (cranial MRI) with contrast medium and fine layering of the brainstem (high-resolution MRI with 3D (T2) and CISS sequences), if necessary with MR angiography (imaging of blood vessels by contrast medium), the latter may be useful if neurovascular decompression is sought – Cranial MRI: in … Trigeminal Neuralgia: Diagnostic Tests
To prevent trigeminal neuralgia, attention must be paid to reducing individual risk factors. Behavioral risk factors Touching the face, such as when washing or brushing teeth. Cold Sneezing Environmental pollution – intoxications (poisoning). Heavy metal intoxications
Attacks of pain may occur several times a day for weeks or months. They occur triggered by stimuli such as chewing or brushing teeth, but also from complete rest. In between, there are phases that are free of pain attacks. The following symptoms and complaints may indicate trigeminal neuralgia: General symptoms Pain (sudden onset, tearing, … Trigeminal Neuralgia: Symptoms, Complaints, Signs
