Trigeminal Neuralgia

When the trigeminal nerve is inflamed, neuralgia can occur. This can be divided into two forms. If the cause of the nerve pain is unknown, it is called idiopathic neuralgia.

If the cause is known, one speaks of a symptomatic neuralgia. In trigeminal neuralgia, the jaw branches of the nerve are most frequently affected, but this is usually only on one side. The branch of the eye is affected in symptomatic neuralgia, which is caused, for example, by masses of space.

Trigeminal neuralgia is described as a lightning-fast, electrifying, burning, enormously strong, stabbing pain in the supply area of one or more trigeminal nerve branches. The pain is considered neuropathic pain. The pain attacks can occur spontaneously.

However, they can also be triggered by certain triggers such as chewing, speaking, swallowing, brushing teeth or similar. In classic trigeminal neuralgia, the cause is usually unknown. It is also known as idiopathic trigeminal neuralgia.

However, the underlying mechanism, the so-called pathomechanism, has been partially investigated. The research is not yet completed. It is suspected that the pathomechanism is related to a “vascular-nervous conflict”.

This means that a vessel compresses one or more nerve branches of the facial nerve. This is probably the A. cerebelli superior. This is usually caused by a degenerative change in the vessel.

This can then lead to a permanent irritation of the facial nerve. The pulsating branch of the vessel can squeeze the nerve. In the long term, the insulation of the trigeminal nerve may be damaged.

This isolation is also called myelin sheath. If it is damaged or missing, direct contact between sensitive fibers that transmit pain can occur. This can cause the pain attacks that are characteristic of trigeminal neuralgia.

The attacks are repeated several times a day (up to 100 times or more). Those affected are often so severely afflicted by their pain that a significant psychological impairment up to depression or suicidal thoughts can be observed. In classic trigeminal neuralgia, the pain attacks begin spontaneously at the beginning, without external irritation.

In the course of time, external stimuli can trigger the pain attacks. In advanced trigeminal neuralgia there are different triggers. These can be chewing, speaking, swallowing, drinking, brushing teeth, cold drafts, mimic movements or touching.

This can severely restrict the quality of life of the affected person and put a great deal of emotional strain on him/her.Depending on the trigger, patients can only partially predict, control or prevent the triggering of a pain attack. This is the reason why many affected persons no longer leave their apartment or house. Some patients also avoid washing and shaving the corresponding area of the face, as these activities can trigger an irritation of the facial nerve.

The level of suffering in classic trigeminal neuralgia is very high. In the course of the disease, mood changes may occur accordingly. Unfortunately, these reactive, resulting anxieties and depressive moods are often wrongly regarded as the “cause” of the disease.

The pain attacks of a classic trigeminal neuralgia are typically of short duration. They rarely exceed 2 minutes. Often the symptoms occur only sporadically.

For weeks or months, there may be no symptoms. These attacks can also occur up to 100 times a day. Permanent pain does not usually occur.

Between the pain attacks there is relative freedom from symptoms. Since the pain is often described as “devastating”, the person affected also suffers between attacks. Fears of the next pain attack can arise.

Depending on the cause, the pain attacks can occur untreated for a few days to many months or even persist for years. In some cases an atypical facial pain occurs that does not correspond to the described pain character and duration. Temporary paralysis may occur when corresponding motor nerve fibers of the face are severely irritated or damaged.

This can happen, for example, in the course of a migraine attack. Therefore, among other things, migraine can lead to short-term facial paralysis. Since the paralysis usually affects only one half of the face, temporary facial paralysis is often confused with a stroke.

This is because a stroke can also lead to hemiplegia of one side of the face. As a rule, a stroke occurs, but not with the described pain. Nevertheless, even if there is little suspicion of a stroke, you should always act quickly as a precaution.

An emergency doctor should be informed as soon as possible. Inflammation of the facial nerve branches can also lead to persistent paralysis in some cases. Whether the paralysis is temporary or permanent is best determined by a neurologist.

In addition, the neurologist can find out the cause and initiate appropriate treatment. If the paralysis of the face is persistent, logopaedic and/or occupational therapy is usually advisable. Depending on the motor nerve branch failure in the face, speech and/or swallowing can also be difficult.

In the context of a classic trigeminal neuralgia, there is often an uncontrollable twitching of the facial muscles in the affected area in the middle of a pain attack. This is referred to as clonic-tonic movements of the musculature. After the pain attack, the affected area is no longer excitable for seconds to minutes. This means that shortly after an attack of pain, another attack cannot be directly triggered again by sensitive stimuli.