Trigeminal neuralgia (TN) is a neurologic disorder characterized by intensive pain attacks from trigeminal nerve and leading to pinching pain in one or both sides of the face (along with facial convulsions). This is one of the most severe pain known to human. Most often this type of pain originate after reaching 50 years of age, but there are certain cases when TN develops in children; more common in women than in men.
Trigeminal nerve is a paired cranial nerve running from brain and splitting in three branches at the base of the brain. Rather rarely it affects both sides of the face. Most often disorders are caused by the middle and lower nerve branches. Pain can radiate to eyes, nose, lips, forehead, skin of the head under hair, cheeks, teeth, gums.
The disorder is accompanied  by intense pain from few seconds, minutes to hours; this pain comes in attacks. Patients describe this pain as spontaneous saying that they are activated by speech, eating, shaving, brushing teeth and manifest as an electric shock, burn, compression, burning, shooting pain. The pain is provoked by loud music, wind, noise; therefore, stay away from these factors. TN can combine with migraine headache.
Trigeminal nerve is a mixed cranial nerve with sensory functions (pressure, temperature, pain), motor functions innervating muscles (biting, facial). There are several theories about source of the pain (exit site from the base of the skull) – intracerebral blood vessel enlargements, blood vessel aneurism, arteriovenous malformation, tumors, arachnoid cyst or brain trauma (all these processes damage myelin sheath which protects nerves and encourage trigeminal nerve irritation). In case of enlarged blood vessels, surgical therapy can be an option.
TN must be diagnosed and treated as soon as possible because the longer a patient suffers from TN, the longer time is needed to treat the pain. Dentists lack knowledge about TN causes and often pull out patient’s teeth but fail to gain any positive results from that (shooting, severe pain persists or even gets worse).
TN pain treatment must be started with neurological testing, if necessary, with brain MRI (to exclude changes in the brain or blood vessels thereof). Further therapy as per instructions of a neurologist. There are many different methods for TN treatment; most often used is alcoholization of branches of trigeminal nerve which stops the transmission of pain impulse and releases the patient from pain. Most often medicines must be used in combination with nerve alcoholization, but this does not mean that there will be no relapses in a while. Medicines for calming pathological nerve impulsions must be prescribed for long-term use. Most often used medicines are Finlepsin, Gabepantin, Neurontin.
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