Trigeminal Neuralgia
Trigeminal neuralgia can be recognized by a characteristic pain localization: above the eyes, on the cheek bones or in the chin area. Between the individual, usually quite short attacks, the patients are free of symptoms, but in pronounced cases there can be a very high frequency of attacks with almost no pauses between attacks. The localization is based on the physiological function of the nerve, which is responsible for the sensitive supply of the front half of the face and the motor function of the temporal and masticatory muscles.
Damage to it can occur throughout its entire course. Due to the strong psychological strain, depressive moods often develop. Since the individual pain attacks are only of very short duration, painkillers usually do not help or not sufficiently.
More effective are so-called antiepileptic drugs, drugs that are used to treat epilepsy. Their effect is based on an inhibitory influence on the excitability of nerves, so that they can prevent the seizures and desensitize the nerve. In the context of potentially surgical therapy, the primary aim is to relieve the nerve and remove any pressure stimuli from an adjacent pulsating blood vessel (decompression). With the help of thermocoagulation, radiological procedures or a so-called CyberKnife, the transmission of pain can also be interrupted. However, the risk of undesirable side effects such as sensory disturbances, hearing and vision problems is very high and relapses are by no means ruled out.
“Atypical facial pain”
In demarcation to the tigeminus neuralgia, which is called “typical face pain“, there is also the group of “atypical face pain”. Facial pain is classified in this category if the criteria for neuralgia are not met. Tension in the neck muscles, but also in the facial muscles, can lead to this pain.
Although the exact mechanism is not yet understood, it is assumed that the free nerve endings are irritated by the tensed subcutaneous connective tissue and can radiate this irritation into the facial area. Affected persons are increasingly female and often describe the pain as a dull, hard-to-define pain, relatively deep-seated and often in the area of the upper jaw or the eye sockets. Sometimes this area can also be hypersensitive to touch.
Patients often visit a dentist first, because they classify the pain as deep-seated, and so it sometimes comes to unnecessary tooth extraction. However, this does not improve the pain, so further procedures are often performed, which only aggravates the unrecognized atypical facial pain and can contribute to its chronicity. Patients are frustrated, discouraged and do not know what to do, and depression and anxiety disorders may occur.
A “Atypical facial pain” should be carefully examined and the possible causes must be urgently clarified. After the affected patients have been carefully informed, a medication with tricyclic antidepressants can be pain-relieving.Massages, cold and heat treatments and other manual therapies are also very promising. A combination of drug, psychotherapeutic and manual therapy is best chosen. Surgical interventions are not recommended, however, as they can promote chronification.
