Trigeminal nerve neuralgia| Symptoms, diagnosis & treatment in Turkey 2024

Trigeminal neuralgia: What is it?

The trigeminal nerve is the main sensory nerve of the face. It divides into three main branches that innervate different areas of the face: the forehead, cheek, and jaw. When this nerve is irritated, often by compression of a blood vessel, it causes attacks of intense, shooting pain.

These attacks, known as trigeminal neuralgia, manifest as repeated electrical discharges localized to one or more branches of the nerve. They can last from a few seconds to several minutes and can be triggered by facial movements, temperature changes or even touch. Patients often describe the pain as excruciating and disabling.

Symptoms of trigeminal neuralgia

Trigeminal neuralgia is characterized by paroxysmal, extremely severe attacks of facial pain concentrated on one side of the face. These pains, often compared to electric shocks, can be triggered by mild stimuli such as washing the face, eating, or even smiling. They can radiate to the ear and cause involuntary muscle spasms. These recurrent attacks, which can occur several times an hour, have a significant impact on patients' quality of life and often prevent them from leading a normal life. The searing nature and high frequency (up to several hundred attacks per day) have a significant impact on patients' quality of life.

In addition to stabbing pain, trigeminal neuralgia may be accompanied by other symptoms, such as:

• Abnormal sensations: tingling, burning, numbness.
• Hypersensitivity to touch, cold, or heat.
• Involuntary muscle contractions.
• Sleep disturbances associated with nighttime attacks.

Trigeminal neuralgia must be distinguished from migraine, which is a diffuse, pulsating pain accompanied by other symptoms such as nausea and photophobia. In contrast, trigeminal neuralgia is usually localized to a specific area of the face, often around the mouth or eye. Recognizing these differences can lead to better management of each condition and improved quality of life for those affected.

Causes of trigeminal neuralgia

Trigeminal neuralgia, a painful condition that primarily affects adults and the elderly, is often caused by compression of the fifth cranial nerve. This compression can be caused by:

• Vascular compression: A blood vessel (artery or vein) can compress the trigeminal nerve, causing severe pain.
• Tumor lesions: A tumor can pressure the nerve, causing neuralgia.
• Vascular malformations: Abnormalities of the blood vessels, such as arteriovenous malformations or aneurysms, can cause pain.
• Neurological diseases: Certain inflammatory diseases, such as multiple sclerosis, or viral infections, such as shingles, can affect the trigeminal nerve and cause pain.

How can trigeminal neuralgia be prevented?

Although painful, trigeminal neuralgia can be prevented in some cases. Prevention methods vary depending on the cause of the condition:

• Maintain a healthy weight: Being overweight can lead to nerve compression, a common cause of mechanical neuralgia.
• Strengthen facial muscles: Regular muscle-strengthening exercises can help relieve muscle tension and, in some cases, prevent the onset or worsening of the disease.
• Get vaccinated against chickenpox: The chickenpox vaccine is the most effective way to prevent shingles, which can cause postherpetic neuralgia.

If you have unexplained facial pain, don't hesitate to see a neurologist. Early diagnosis will allow the most appropriate treatment to be considered.

Evaluation & Diagnosis

The diagnosis of trigeminal neuralgia is based primarily on a thorough clinical evaluation of the symptoms described by the patient. The characteristic pain, often described as intense, brief electrical discharges localized to a specific area of the face, is highly suggestive.

Brain MRI

To refine the diagnosis and identify possible underlying causes, a brain MRI with specific sequences is performed. This examination allows us to visualize the trigeminal nerve region and to detect :

• A vascular conflict: Compression of the nerve by a blood vessel is the most common cause of typical trigeminal neuralgia.
• An underlying lesion: A tumor, inflammatory lesions, or other abnormalities may also cause pain.

Neurological examination

The neurological examination is usually normal in patients with typical trigeminal neuralgia. The presence of neurological deficits (decreased cutaneous sensitivity, muscle weakness, etc.) suggests other pathologies that may mimic trigeminal neuralgia, such as :

• Cerebral tumors.
• Cerebrovascular accidents.
• Multiple sclerosis.
• Vascular malformations.
• Other lesions that compress or damage the trigeminal nerve.

Treatment of facial neuralgia in Turkey

Treating trigeminal neuralgia requires several approaches. Here are the typical steps:

Drug treatments

Treatment of neuralgia usually combines analgesics and anti-inflammatories administered orally, intramuscularly, or by parietal infiltration. The goal of medical treatment is to reduce the intensity of symptoms.

Conventional analgesics and morphine cannot completely relieve trigeminal neuralgia. Your doctor may prescribe other medications, including

• Anticonvulsants (anti-epileptics).
• Antispasmodics.
• Antidepressants, anxiolytics, and neuroleptics (as an adjunct).

In the case of mechanical neuralgia, the patient should rest for a few days. The attending physician may also recommend that the patient wear a cervical collar or undergo physiotherapy.

The neurosurgery

Although medication treatment is often effective, some patients show resistance to painkillers. In this case, the doctor may consider surgery to relieve the pressure on the nerve.

There are three types of surgery: