Neuralgia / trigeminal neuralgia

Neuralgia describes pain in an area innervated by a certain nerve. Pain is caused by the nerve or the brain without an exterior damage. Neuralgia can potentially affect every nerve. The most common form of neuralgia is trigeminal neuralgia.
Nervus trigeminus is a facial nerve with sensory (perception of being touched) and motory (control of facial muscles) functions. It has its origin in the brainstem and proceeds through the skull base. Nervus trigeminus splits up into three branches for the innervation of face and skull. In case of trigeminal neuralgia, mostly only one of these branches is predominantly affected:

  • forehead and eyes
  • cheek, upper jaw and corresponding teeth
  • lower jaw

Symptoms trigeminal neuralgia

Regarding the classic (idiopathic) example of trigeminal neuralgia, a fit-like pain plagues the person around eye, upper or lower jaw, depending on the affected branch. The pain can be described as ‘pain of annihilation’. Pain of annihilation is almost unbearable. People feel as they would be on someone´s mercy and suffer from extreme anxiety. The fits can happen several times a day for minutes up to hours and can be triggered by, for example, coldness, chewing, breeze or touch. At worst pain can reach such an unbearable level that people have suicidal tendencies.

Trigeminal neuralgia is characterized by acute, fit-like pain that can be triggered. If people face a chronic pain that sustains continuously over days, weeks or months, it is no trigeminal neuralgia. It is a so-called atypical face ache (prosopalgia), which has other causes and therapy options. Here are the symptoms of trigeminal neuralgia in an overview:

  • pain afflicting one side of the face in the form of severe and suddenly occuring pain intervals lasting from only split seconds to a few minutes, interrupted by intervals free of pain
  • afflicted persons often describe the pain as lightning or power surge
  • often only one branch of the trigeminal nerves and corresponding areas is afflicted, but complaints can spread to all areas/branches
  • external triggers can cause neuralgic pain to start like cold, wind, touch, chewing, or swallowing
  • to avoid pain people often shun food and water as well as taking drugs orally
  • contractions of facial muscles (tic douloureux), redenning of the face, flood of tears or sweat

Cause trigeminal neuralgia

We distinguish idiopathic (classic) trigeminal neuralgia and symptomatic trigeminal neuralgia. Idiopathic trigeminal neuralgia takes place spontaneously without any tangible cause. Symptomatic trigeminal neuralgia has a cause, for example, inflammation (often multiple sclerosis – MS), vascular malformation or, rarely, a tumor. Here is an overview about the causes of trigeminal neuralgia:

  • compression (clamping) through vessels, tumors or other tissue
  • inflammations, e.g., caused by herpes zoster or multiple sclerosis
  • metabolism disorders like diabetes mellitus
  • radiation
  • chemical burns, e.g., noxious gases
  • injuries, traumata
  • diopathic (i.e., without any tangible cause)

Other nerves of the skull, the so-called cranial nerves, can be similarly affected (glossopharyngeal neuralgia, accessory neuralgia, etc.).

Treatment trigeminal neuralgia

Depending on the afflicted area and cause of nerve damage, there are different therapy options. Generally, one will try a drug therapy with special drugs like antiepileptic drugs (anticonvulsants) or antidepressants. The classic trigeminal neuralgia (idiopathic) is cured with drugs. Beforehand, a neuroradiological MRI is conducted to rule out symptomatic trigeminal neuralgia. Applied drugs derive from epileptology where they are used to treat epileptic fits. They reduce the electrical irritability of the brain. Because neuralgia is based on hyperexcitability of nerves, these drugs are successfuly used in case of trigeminal neuralgia. Examples of drugs are Carbamazepin, Gabapentin and Prigabalin. Alternatively, trigeminal neuralgia is also treated by acupuncture or TCM (traditional Chinese medicine).

If trigeminal neuralgia is not curable, in case of being severe or medically resistant, or in case of a mechanically compressed (clamped) nerve, sugery is an option. Earlier methods like obliteration of ganglia of skull base are no longer state-of-the-art because of a very successful microsurgical technique, the so-called decompression of the trigeminal nerve after Jannetta. This surgery takes place in the posterior cranial fossa. Jannetta is the man, who described the procedure first. During Jannetta surgery, a layer consisting of muscle tissue, fascia or synthetic material is placed between a clamping vessel and the trigeminal nerve to speparate them from each other.