Why does it occur
The trigeminal nerve is responsible for facial sensitivity and is divided into three branches: the ophthalmic, maxillary and mandibular. In most cases, the cause of neuralgia is compression of the nerve root by a loop of the artery at its exit from the brain stem. The constant pulsation of the vessel damages the insulating sheath of the nerve, and it begins to generate pain impulses in response to the most common touch.
Less commonly, the cause is multiple sclerosis, in which the same membrane is destroyed, a tumor in the area of the cerebellopontine angle, the consequences of injury or herpes zoster.
What does a seizure look like?
- Sudden, one-sided pain that is described as an electric shock, shooting, or flash
- Duration from a few seconds to two minutes, no pain between attacks
- The second and third branches are most often affected - pain in the cheek, upper or lower jaw
- An attack is provoked by trigger points: touching the face, shaving, washing, brushing teeth, chewing, talking, wind
- During an attack, a person freezes and is afraid to move; there may be a painful tic - an involuntary contraction of the facial muscles
- Over time, attacks become more frequent, and light intervals shorten
How is it different from toothache?
You can distinguish them quite confidently, and this saves healthy teeth.
- Neuralgia: lightning-fast pain, attacks in seconds, provoked by touch, does not wake you up at night, conventional analgesics have almost no effect
- Pulpitis and periodontitis: the pain is aching or throbbing, lasts for hours, intensifies at night and from heat, there is a reaction to tapping on a specific tooth, analgesics help
- Dysfunction of the temporomandibular joint: pain is associated with opening the mouth, there are clicks in the joint
- Cluster headache: pain around the eye, 15–180 minutes, with watery eyes and nasal congestion
A simple rule of thumb: if the pain lasts a split second and is triggered by a light touch to the face, and painkillers do not help, it is almost certainly not a tooth.
Survey
- Осмотр невролога с проверкой чувствительности лица и работы жевательных мышц, поиском триггерных зон.
- МРТ головного мозга — main метод: выявляет сосудистый конфликт, очаги демиелинизации, опухоли.
- КТ основания черепа и лицевого скелета — при подозрении на костную патологию и последствия травм.
- Консультация стоматолога с прицельными снимками, чтобы исключить одонтогенную причину.
Treatment
Conventional painkillers for trigeminal neuralgia are practically ineffective - the pain is neuropathic in nature. The basis of treatment is anticonvulsants, primarily carbamazepine, which in most patients provides significant relief in the first days.
- Anticonvulsants are basic therapy; the dose is selected gradually, under the supervision of a doctor and tests
- If the effect is insufficient - combinations of drugs and second-line drugs
- Blockades with local anesthetics - for temporary relief
- Microvascular decompression is an operation in which a spacer is placed between the vessel and the nerve; the most radical method for vascular conflict
- Radiofrequency destruction and radiosurgery - with contraindications to open surgery
- Physiotherapy - as an auxiliary method, as prescribed by a doctor
What to do at home
- Avoid hypothermia of the face, wind and drafts, cover your face with a scarf in winter
- Wash with warm water, use a soft brush
- Eating warm, soft foods during an exacerbation
- Keep a diary of attacks: what triggers them, how long they last, what helps
- Do not extract teeth “just in case” without a proven dental reason