A relaxing breakfast on Sunday morning. While chewing the delicious roll, a stabbing pain shoots in one side of the face in a flash. This is over after a few seconds, but so intense that the tears come. The name says it all: trigeminal, the triplet nerve, is the name for the fifth cranial nerve, neuralgia means nerve pain.
Where does the pain of trigeminal neuralgia come from?
Trigeminal neuralgia usually causes pain in one, or more rarely two, of the three branches of one of the two trigeminal nerves that symmetrically supply large parts of the face:
- The first branch, which is rarely affected, mediates sensations from the lacrimal gland, orbit, and forehead
- The second, most commonly affected branch supplies facial skin, nasal mucosa, upper lip and maxillary teeth
- The third branch mediates sensations in the mandibular region and supplies the muscles of mastication and floor of the mouth.
In Germany, about one in 3,000 is affected by trigeminal neuralgia; mainly people aged 50 to 70 years, women slightly more often.
How does trigeminal neuralgia develop?
Depending on the cause, the much more common classic trigeminal neuralgia is distinguished from secondary trigeminal neuralgia, which develops on the basis of other disorders. In the first form, the nerve is irritated for years by a tightly fitting blood vessel loop and eventually its protective sheath is damaged. This causes a “short circuit” between otherwise separate nerve fibers, so that normal stimuli such as touch are perceived as pain sensations.
In secondary trigeminal neuralgia, nerve damage occurs, for example, due to pressure from a tumor, from herpes viruses, or in the context of multiple sclerosis. Because the cause of the classic form was long unknown, it is also referred to as the idiopathic (“with an unexplained cause”) and the non-idiopathic form.
What are the manifestations of trigeminal neuralgia?
Primary headache and facial pain can manifest with a wide range of symptoms. The pain can range from a few seconds to years. Typical of classic trigeminal neuralgia are the extremely short attacks, lasting no more than two minutes, but which can occur up to a hundred times a day and are extremely painful – not surprising, since the triplet nerve supplies the facial area, which is already normally very sensitive.
The pains shoot in like lightning, are described as stabbing or burning and are localized exactly in the supply area of the affected trigeminal branch.
Also typically, the attacks are often triggered by touching the area or by certain activities: Chewing, speaking, brushing teeth, shaving, etc. Sometimes there is additional tearing or salivation, reddening of the skin or muscle twitching in the affected half of the face.
The pain is usually so unbearable that sufferers lose a lot of weight over months because they are afraid to chew, and they are not infrequently suicidal. If the trigeminal nerve is irritated by another underlying disease or, for example, dental root canal treatment, the symptoms may also be atypical: for example, the pain lasts longer but is less severe, or the skin is numb in the area supplied by the nerve.
