There are few pains that cause as much disability and discomfort as ear-related pains or toothaches. Fortunately for the person who suffers from them, they are temporary and can be easily remedied.

Now, let us imagine that these pains appear in a fortuitous and chronic way and that, in addition, the treatments could not make the pain go away permanently. This is what happens in trigeminal neuralgia, a very painful disorder which we will discuss below.

What is trigeminal neuralgia?

The condition known as trigeminal neuralgia is a chronic, lacerated condition caused by an alteration in the trigeminal nerve or fifth cranial nerve . This trigeminal nerve is one of the longest nerves in the skull.

Among the effects that trigeminal neuralgia causes in the person is a sensation similar to that caused by burning, which appears suddenly and unexpectedly (Type I), in addition these patients may also experience a sensation of intense and sharp pain that can last up to two minutes (Type II). Hence, this disease is also known as painful tic.

The pain caused by this condition can be so intense that the person is practically incapacitated both physically and mentally.

To understand this condition well, it is necessary to know that this trigeminal nerve is part of the twelve pairs of cranial nerves that start from the base of the skull. Its function is to transport sensations between the brain and the upper, middle and lower areas of the face and into the oral cavity. This nerve is formed by three branches:

  • The ophthalmic or superior branch transports the sensations to almost the entire scalp, forehead and frontal area of the head.
  • The maxillary or middle branch crosses the cheek, the upper jaw, the upper lip, the teeth, the gums and the sides of the nose.
  • The mandibular or lower branch that runs along the jaw, teeth, gums and lower lip.

In trigeminal neuralgia, more than one nerve branch can be affected, causing intense pain in any of the areas mentioned above.

What symptoms do you have?

As previously mentioned, the symptoms associated with trigeminal neuralgia are distinguished by the fact that they cause the patient a lacerating and acute pain or suffering, similar to an electrical discharge that is usually felt on one side of the jaw or on the cheek .

These episodes of pain can occur on either side of the face. However, they never occur on both sides at once.
The complete symptomatology that can occur in trigeminal nerve neuralgia includes

  • Contractions that cause very intense pain , such as an electric shock, lasting up to two minutes and which can occur constantly.
  • Usually the pain only appears on one side of the face . Specifically in the eye, the cheekbone and the lower part of the face.
  • When the pain appears there is no subsequent numbness and the ability to move the affected area of the face is not lost either .

In most cases, patients can anticipate the onset of the episode since it tends to be preceded by tingling sensations, stiffness, or a mild but continuous pain sensation.

One of the main characteristics of this symptomatology is that it appears suddenly and randomly. However, these incidents can be triggered by a vibration or contact with the cheek caused by any everyday action such as washing the face or teeth, eating or even talking.

Even though trigeminal neuralgia does not per se pose a risk to the person’s health, the pain it causes can become highly disabling, causing the person to refuse by all means to perform those daily tasks that could cause a new crisis .

What causes this type of neuralgia?

Although in many cases the cause of trigeminal neuralgia remains undetermined, there are a number of situations and diseases that lead to the appearance of these characteristic episodes of pain .

The contexts in which it can appear are:

  • Compression of the trigeminal nerve by a blood vessel: this compression can be either by the normal aging process itself or by the presence of a tumor.
  • Multiple sclerosis (MS) or other diseases that cause myelin to deteriorate
  • Trigeminal nerve injury due to trauma or oral or sinus surgery

How is it diagnosed?

At present, no specific test has been developed for the diagnosis of trigeminal neuralgia.

The steps to follow for an accurate diagnosis of trigeminal neuralgia are

  • Exploration of the person’s medical history .
  • Description of symptoms.
  • Physical examination.
  • Comprehensive neurological examination .
  • Carrying out neuroimaging studies to rule out the action of a brain tumour or multiple sclerosis

What is treatment and what is the prognosis?

As with diagnosis, no treatment has yet been discovered that has the ability to permanently eliminate the pain caused by trigeminal neuralgia.

However, there are several treatments or interventions that can significantly improve the patient’s situation . These treatments are drug therapy, surgery and other treatments or remedies.

1. Drug therapy

There are certain medications that often help to reduce pain and the number of attacks. These medications include

  • Anticonvulsant medication : is the most effective and may include carbamazepine, topiramate or gabapentin.
  • Administration of opioids such as methadone when neither anticonvulsants nor surgery work
  • Treatment using low-dose antidepressants such as nortriptyline
  • Morphine derivatives like dolantine.
  • Botox injections into the nerve.

2. Surgery

A second option is the solution through certain types of surgeries. However, the effectiveness of their results is widely discussed by the medical community.

The main practice performed in trigeminal neuralgia is microvascular decompression (MVD), in which the surgeon places an element between the nerve and blood vessel that puts pressure.

Other strategies consist of undoing or sectioning some areas of the nerve root using the following techniques:

  • Glycerol injection .
  • Radiosurgery.
  • Radiofrequency ablation.
  • Microcompression with percutaneous balloon.

3. Other remedies

The person affected by trigeminal neuralgia may also benefit from the effects of alternative treatments such as acupuncture or chiropractic combined with medication, because of suggestion .
The use of capsaicin creams, modification of eating habits or cyanocobalamin supplements may also be helpful in reducing the intensity of symptoms.