Inflammation, treatment, symptoms, neuralgia, neuritis, trigeminal nerve pain

What is inflammation of the trigeminal nerve, trigeminal neuralgia?

Trigeminal neuralgia - this is pain spreading along the trigeminal nerve or its branches, sometimes with hyper- or hypoesthesia in the zone of its innervation.

Inflammation of trigeminal neuralgia: causes

What are the causes of inflammation, neuritis, trigeminal neuralgia? Causes of trigeminal neuralgia are various inflammatory (inflammation), traumatic (damage), toxic, infectious (infections, including herpes - postherpetic neuralgia), allergic, infectious-allergic, metabolic effects. Compression of nerves (pinching) in bone, musculoskeletal and osteoarticular canals, prolonged microtrauma, especially in combination with hypothermia, and foci of focal infection also play an important role.

Inflammation, trigeminal neuralgia symptoms

Trigeminal neuralgia clinically manifested by short-term attacks of excruciating pain, often in the area of ​​the 2nd and 3rd branches of the trigeminal nerve. It is characterized by the presence of trigger zones on the skin and mucous membranes. Touching them provokes attacks of pain. In most cases attack of pain accompanied by severe local and general autonomic disorders, the following symptoms: facial hyperemia (redness of the face) and swelling on the affected side, lacrimation, rhinorrhea (discharge of watery mucous discharge from the nose), hypersalivation (salivation, increased secretion of the salivary glands), possibly increased blood pressure ( blood pressure), chills-like trembling, difficulty breathing.

Trigeminal nerve, anatomy, innervation, where the trigeminal nerve is located

The trigeminal nerve, nervus trigeminus, the 5th pair of human cranial nerves is a mixed nerve that contains sensory, motor and autonomic fibers. The functions of the trigeminal nerve are varied.

Sensitive fibers trigeminal nerves originate from the cells of the trigeminal nerve ganglion, which is called the ganglium trigeminale. It is located in the recess of the pyramid of the temporal bone. The dendrites of these cells form 3 branches and 3 trunks.

1 branch of the trigeminal nerve, first branch(nervus ophthalmicus) - the ophthalmic nerve passes in the lateral wall of the cavernous sinus, later through the superior orbital fissure into the orbit. Then it breaks up into branches, innervates such structures as the outer part of the conjunctiva, the skin of the outer corner of the eye, the upper eyelid, the lacrimal gland, the skin of the scalp to the temporal and parietal regions, the skin of the forehead, the skin of the root of the nose, the cornea, the frontal sinus, the main sinuses , nasal mucosa, nasal skin, posterior cells of the ethmoid bone.

2nd branch of the trigeminal nerve, second branch(nervus maxillaris) - the maxillary nerve passes (exit) through the round foramen and the pterygopalatine fossa. It further breaks down into branches and innervates the following sections: the skin of the temporal region (temporal region, temple), the skin of the zygomatic region (cheekbone), the mucous membrane of the posterior ethmoid cells and the main sinus, the vault of the pharynx (pharynx), the nasal cavity (nose), the soft palate, hard palate, mucous membrane of the tonsils (tonsils), skin of the infraorbital region (infraorbital region), wings of the nose, upper lip, gums of the upper jaw, upper teeth.

3rd branch of the trigeminal nerve, third branch(nervus mandibularis) - the mandibular nerve leaves the skull through the foramen ovale (exit point, place of exit), innervates the following areas: mucous membrane of the cheek, mucous membrane of the lower gum (lower gum), skin of the angle of the mouth (corner of the mouth), skin of the external auditory canal , anterior part of the auricle, temple, all lower teeth, skin and mucous membrane of the lower lip.

Motor fibers The trigeminal nerve originates from the motor nucleus nucleus motorius nervi trigemini. The core is located in the bridge tire. Fibers extending from the nucleus leave the cranial cavity through the foramen ovale. They innervate the masticatory muscles and the anterior belly of the digastric muscle. The axons of the trigeminal ganglion cells form a root and go to the bridge, where they divide into 2 branches.

The descending branch forms the descending spinal tract of the trigeminal nerve, which is responsible for conducting temperature and pain sensitivity. It ends in the nucleus spinalis nervi trigemini. The descending spinal tract and its nuclei are analogous in their function and structure to the posterior horns of the spinal cord. The nuclei and path are divided into 5 segments, as a result of which the innervation of the facial skin in the Zelder zones is located in a ring.

Primary trigeminal neuralgia, secondary trigeminal neuralgia

Distinguish primary trigeminal neuralgia(idiopathic, essential, typical) and secondary trigeminal neuralgia(symptomatic trigeminal neuralgia).

With primary neuralgia (mainly of central origin), attacks occur for no reason or are provoked by any movements of the facial muscles.

Secondary neuralgia is usually a complication of the primary disease, has a predominantly peripheral genesis and is often caused by pathological processes in the dentofacial area. The pain is almost constant, periodically intensifying in the form of attacks lasting up to several hours.

Trigeminal nerve, symptoms of trigeminal nerve damage, pathology

Damage to one of the sensory branches of the trigeminal nerve results in a disturbance of all types of sensitivity on the face of a peripheral type in the zone of innervation of this branch. In this case there are symptoms: pain, decreased reflexes, fading reflexes. When the optic nerve is damaged, the conjunctival reflex, corneal reflex, and superciliary reflex are affected. When the motor part of the mandibular nerve is damaged, the mandibular reflex suffers. When the trigeminal nerve ganglion is damaged, all types of sensitivity in the area of ​​3 of its branches are lost, herpetic eruptions (herpes, herpetic blisters), and trophic disorders are often observed. A lesion of one of the sensitive nuclei in the pons results in a dissociated type of sensitivity disorder - superficial or deep. When the nucleus and oral parts of the spinal tract are damaged, a violation of superficial types of sensitivity in the mouth and nose occurs. If the caudal region is affected, sensitivity is impaired in the area of ​​the outer part of the face. When the optic thalamus and the posterior third of the posterior limb of the internal capsule are affected, contralateral hypersthesia is observed on the face, trunk (body), and limbs (arms, legs) according to the hemitype. When the motor nucleus and its fibers are damaged, peripheral paresis occurs, which is characterized by symptoms such as insufficient muscle tension when chewing, muscle atrophy, retraction in the temple area, angle of the lower jaw, deviation of the lower jaw towards the affected side when opening the mouth. If bilateral peripheral paresis occurs, the lower jaw droops, as a result of which a man or woman cannot chew, cannot close his teeth, or close his mouth. Central paresis of the masticatory muscles on one side does not occur, since the corticonuclear fibers approach the motor nucleus of the trigeminal nerve from both hemispheres of the brain. With bilateral lesions, chewing becomes slightly more difficult (difficulty chewing), and the mandibular reflex is significantly enhanced. Small children have difficulty sucking.

Trigeminal neuralgia folk remedies

Unfortunately, folk remedies, tablets, drugs, medications, massage, herbs in the treatment of diseases, illnesses, trigeminal neuralgia give a small and short-term effect.

Treatment of trigeminal neuralgia in Saratov, how to treat trigeminal neuralgia in Russia

Sarklinik provides comprehensive treatment of trigeminal neuralgia in children, in adults, treatment of inflammation of the trigeminal nerve (nervitis, first, second, third branches) in Saratov, Russia, which includes effective reflexology methods. You can cure trigeminal neuralgia in Saratov!

Sarklinik knows how to treat inflammation of the trigeminal nerve, how to cure neuralgia and trigeminal neuritis ! The following types of neuralgia are treated: neuralgia of the 1st (first) branch of the trigeminal nerve, neuralgia of the 2nd (second) branch of the trigeminal nerve, neuralgia of the 3rd (third) branch of the trigeminal nerve in children and adults. . If you have neuropathy, nerve damage, pain, a cold, the trigeminal nerve hurts on the left, right, you have a cold, a cold, inflammation on the face, paralysis, paresis, you don’t know, how to relieve pain, then contact a doctor at Sarklinik.

There are contraindications. Specialist consultation is required.

Photo: Aniram | Dreamstime.com\Dreamstock.ru. The people depicted in the photo are models, do not suffer from the diseases described and/or all similarities are excluded.

Trigeminal neuralgia does not go away painlessly; it is a rather serious illness. This disease most often affects older women. In some cases, even surgery is required.

What is neuralgia, types of disease

The trigeminal nerve originates from the trunk of the anterior part of the pons, located next to the middle cerebellar peduncles. It is formed from two roots - a large sensory root and a small motor one. Both roots from the base are directed to the apex of the temporal bone.

The motor root, together with the third sensory branch, exits through the foramen ovale and further connects with it. In the depression at the level of the upper part of the pyramidal bone there is a semilunar node. Three main sensory branches of the trigeminal nerve emerge from it (see photo).

Neuralgia in translation means pain along the nerve. Having 3 branches, the trigeminal nerve is responsible for the sensitivity of one side of the face and innervates strictly defined areas:

• 1 branch - orbital region;
• 2nd branch - cheek, nostril, upper lip and gum;
• 3rd branch - lower jaw, lip and gum.

All of them, on their way to the innervated structures, pass through certain openings and channels in the bones of the skull, where they can be subjected to compression or irritation. Neuralgia of the 1st branch of the trigeminal nerve is extremely rare; most often the 2nd and/or 3rd branches are affected.

If one of the branches of the trigeminal nerve is affected, a variety of disorders may occur. For example, the area of ​​innervation may become insensitive. Sometimes, on the contrary, it becomes too sensitive, almost to the point of being painful. Often part of the face seems to sag or becomes less mobile.

Conventionally, all types of trigeminal neuralgia can be divided into primary (true) and secondary neuralgia.

1. Primary (true) neuralgia is considered a separate pathology that occurs as a result of compression of the nerve or impaired blood supply in this area.
2. Secondary neuralgia is the result of other pathologies. These include tumor processes and severe infectious diseases.

Causes

The exact cause of the development of trigeminal neuralgia is not clear; as mentioned above, it is an idiopathic disease. But there are factors that most often lead to the development of this disease.

The reasons for the development of trigeminal neuralgia are varied:

• compression of the nerve in the area of ​​its exit from the cranial cavity through the bone canal with an abnormal arrangement of cerebral vessels;
• aneurysm of a vessel in the cranial cavity;
• metabolic disorders: gout, diabetes, thyroid diseases and other endocrine pathologies;
• hypothermia of the face;
• chronic infectious diseases in the facial area (chronic sinusitis, dental caries);
• mental disorders;
• suppuration of the bones of the skull, especially the jaws (osteomyelitis);
• severe allergic diseases;
• helminthiasis (worms);
• multiple sclerosis;
• brain tumors.

Symptoms of trigeminal neuralgia

The disease is more typical for middle-aged people, and is more often diagnosed. Females suffer more often than males. Damage to the right trigeminal nerve is most often observed (70% of all cases of the disease). Very rarely, trigeminal neuralgia can be bilateral. The disease is cyclical, that is, periods of exacerbation are followed by periods of remission. Exacerbations are more typical in the autumn-spring period.

So, typical signs of pain syndrome with trigeminal neuralgia:

• the nature of the pain in the face is shooting, extremely hard; patients often compare it to an electric shock
• Duration of an attack of neuralgia - seconds (no more than two minutes)
• the presence of a refractory period (the interval between attacks)
• localization of pain - does not change for several years
• pain of a certain direction (from one part of the face goes to another)
• the presence of trigger zones (areas of the face or oral cavity, irritation of which causes a typical paroxysm)
• the presence of trigger factors (actions or conditions under which a painful attack occurs; for example, chewing, washing, talking)
• The characteristic behavior of the patient during an attack is the absence of crying, screaming and a minimum of movements.
• twitching of the chewing or facial muscles at the peak of a painful attack.

Among the secondary symptoms of trigeminal neuralgia, phobic syndrome should be distinguished. It is formed against the background of “protective behavior,” when a person avoids certain movements and postures so as not to provoke an exacerbation of the disease.

1. Chewing food with the side opposite the painful side;
2. Neuropathic complications of neuralgia lead to secondary pain in the head;
3. Concomitant irritation of the auditory and facial nerves.

Symptoms are difficult to interpret correctly if the patient’s pain syndrome is mild.

Due to the fact that all patients suffering from trigeminal neuralgia use only the healthy half of the mouth for chewing, muscle compactions form on the opposite side. With a long course of the disease, dystrophic changes in the masticatory muscles and a decrease in sensitivity on the affected side of the face may develop.

Localization of pain

Painful attacks may not be isolated, but follow each other at short intervals. The pathogenesis of the development of trigeminal neuralgia is very diverse:

1. Usually, unpleasant sensations in any part of the face manifest themselves in the form of an attack.
2. The pain numbs the person for a couple of minutes and temporarily subsides. Then he comes again. Between painful attacks it takes from 5 minutes to an hour.
3. The defeat is reminiscent of being hit with a stun gun. Discomfort is usually localized in one part of the face, but often the patient feels pain in several places at once.
4. It seems to a person that the pain covers the entire head, eye area, ears, nose. It is very difficult to speak during an attack.
5. The pain that cramps the oral cavity makes it extremely difficult to pronounce words. This may cause severe muscle twitching.

Other diseases are similar to the symptoms of trigeminal neuralgia. These include temporal tendonitis, Ernest's syndrome and occipital neuralgia. With temporal tendonitis, pain affects the cheek and teeth, headache and pain in the neck.

With occipital neuralgia, pain is usually located in front and behind the head and can sometimes spread to the face.

What most often causes pain in trigeminal neuralgia?

If the patient has neuralgia, then each attack occurs due to irritation of the trigeminal nerve, due to the existence of trigger, or “trigger” zones. They are localized on the face: in the corners of the nose, eyes, nasolabial folds. With irritation, sometimes extremely weak, they can begin to “generate” a stable, long-lasting painful impulse.

Factors causing pain may be:

1. shaving procedure for men. Therefore, the appearance of a patient with a shaggy beard may lead an experienced doctor to “experienced neuralgia”;
2. just a light stroke of the face. Such patients protect their face very carefully and do not use a handkerchief or napkin.
3. the process of eating, the procedure of brushing teeth. Movements of the muscles of the oral cavity, cheek muscles and pharyngeal constrictors provoke pain as the facial skin begins to shift;
4. fluid intake process. One of the painful conditions, since quenching thirst is punished by severe pain;
5. an ordinary smile, as well as crying and laughing, talking;
6. applying makeup to the face;
7. sensation of pungent odors, which are called “trigeminal” - acetone, ammonia.

Consequences of neuralgia for humans

Trigeminal neuralgia in an advanced state entails certain consequences:

• paresis of facial muscles;
• hearing impairment;
• paralysis of facial muscles;
• development of facial asymmetry;
• prolonged pain;
• damage to the nervous system.

The risk group consists of older people (usually women), people suffering from cardiovascular diseases or metabolic disorders.

Diagnostics

A neurologist needs to differentiate frontal sinusitis, glaucoma, dental diseases, otitis, mumps, ethmoiditis or sinusitis. For this, a comprehensive examination is prescribed.

Typically, the diagnosis of trigeminal neuralgia is made based on the patient’s complaints and examination. Magnetic resonance imaging is important in diagnosing the cause of neuralgia. It allows you to identify a tumor or signs of multiple sclerosis.

Basic diagnostic methods:

1. Consultation with a neurologist. Based on the results of the initial examination, the doctor determines further types of examination.
2. Dental examination. Neuralgia often occurs against the background of dental diseases and poor-quality dentures.
3. Panoramic x-ray of the skull and teeth. Helps to see formations that could be pinching a nerve.
4. MRI. The study helps to see the structure of nerves, the presence and localization of vascular pathologies, and various types of tumors.
5. Electromyography is designed to study the characteristics of the passage of impulses along a nerve.
6. Blood test - allows you to exclude the viral origin of pathological changes in the trigeminal nerve.

If you have been diagnosed with neuralgia, do not be alarmed; in general, the prognosis is favorable, but timely treatment plays an important role.

Treatment of trigeminal neuralgia

It is extremely difficult to cure this disease and even radical treatment methods do not always give a positive result. But proper therapy can relieve pain and significantly alleviate human suffering.

The main treatment methods for trigeminal neuralgia include:

• medicinal;
• physiotherapy;
• surgical treatment.

Medications

Various groups of drugs are used in drug treatment, including:

• Anticonvulsants
• Antispasmodics and muscle relaxants.

Before using any drug, consultation with a neurologist is necessary.

Finlepsin for trigeminal neuralgia is one of the most common anticonvulsants. The active ingredient of this drug is carbamazepine. This drug plays the role of an analgesic for idiopathic neuralgia or a disease that occurs against the background of multiple sclerosis.

In patients with trigeminal neuralgia, Finlepsin stops the onset of pain attacks. The effect is noticeable 8 – 72 hours after taking the drug. The dosage is selected only by the doctor individually for each patient.

The dose of Finlepsin (carbamazepine), with which patients can talk and chew painlessly, should remain unchanged for a month, after which it should be gradually reduced. Therapy with this drug can last until the patient notes the absence of attacks for six months.

Other drugs for trigeminal neuralgia:

Each of these drugs has indications for use in trigeminal neuralgia. Sometimes these drugs do not help, so phenytoin is prescribed at a dose of 250 mg. The drug has a cardiodepressive effect, so it should be administered slowly.

Physiotherapeutic procedures

Physiotherapeutic procedures include paraffin baths, the use of various types of currents, and acupuncture. To get rid of severe pain, doctors give the patient alcohol-novocaine blockades. This is enough for some time, but the blockades are less and less effective each time.

• The following methods are used:
• Acupuncture;
• Magnetotherapy;
• Ultrasound;
• Laser treatment;
• Electrophoresis with drugs.

Surgical treatment of trigeminal neuralgia

During surgical treatment, the doctor tries to eliminate the compression of the nerve trunk by the blood vessel. In other cases, the trigeminal nerve itself or its node is destroyed in order to relieve pain.

Surgical treatments for trigeminal neuralgia are often minimally invasive. In addition, the surgical method also includes the so-called. Radiosurgery is a bloodless intervention that does not require any incisions or stitches.

There are the following types of operations:

1. Percutaneous surgery. Used in the early stages of the disease. Under local anesthesia, the trigeminal nerve is destroyed by exposing it to chemicals or radio waves.
2. Nerve decompression. This operation is aimed at correcting the location of the arteries that compress the trigeminal nerve.
3. Radiofrequency destruction of the nerve root. In this operation, only a certain part of the nerve is destroyed.

The type of operation is prescribed depending on the individual characteristics of the patient’s disease.

A characteristic feature of all surgical methods is a more pronounced effect when performed early. Those. The earlier this or that operation is performed, the higher the likelihood of cure.

Folk remedies for use at home

How to treat neuralgia with folk remedies? When using folk remedies, it is important to remember that only symptoms are relieved in this way. Of course, first of all, you should use folk recipes that can effectively help fight the inflammatory process.

It is important to remember that the use of a particular treatment method should be discussed with a doctor. Pay attention to the consequences that drug treatment may bring.

Folk remedies for treating neuralgia at home:

1. Birch juice. By taking it orally or lubricating it on the side of the face affected by neuralgia, you can reduce the symptoms of the disease. You need to drink 4-5 glasses of this juice per day.
2. The beets are grated on a coarse grater. A small envelope is made from the bandage (the bandage is rolled up in several layers), into which the grated beets are placed. Such a bundle is inserted into the ear canal from the side where the inflammation appears.
3. Black radish juice will also help. It can be mixed with lavender tincture or lavender essential oil and rubbed into the sore spot. Then you should wrap yourself in a scarf and lie there for half an hour. During an attack, it is permissible to fumigate the room in which the patient is located. For this you need a wormwood cigar. It is rolled from dry wormwood leaves and set on fire. Fumigation should last no more than 7-10 minutes. Such manipulations must be carried out within a week.
4. Heat a glass of buckwheat in a frying pan, pour the cereal into a cotton bag and apply to the sore area. The bag is removed when it has completely cooled down. This procedure is carried out twice a day.
5. We treat trigeminal neuralgia with pharmaceutical chamomile - an excellent sedative for NTN. You can make morning tea from it. You should take a certain amount of warm drink into your mouth, but do not swallow it, but hold it for as long as possible.
6. Grate the horseradish root on a coarse grater, wrap the resulting pulp in a napkin and apply it as a lotion to the affected area.
7. To relieve tension in the body and relieve neuralgic pain, hot baths with the addition of a decoction of young aspen bark are recommended.

Prevention

• avoid hypothermia of the face;
• prevention of head injuries.

So, getting rid of ternary neuralgia is possible. You just need to seek help from specialists in time and undergo an examination. The neurologist will immediately prescribe the necessary medications to combat the disease. If such remedies do not help in the fight against trigeminal neuralgia, they resort to the help of a neurosurgeon who solves the problem surgically.

Discussion: 6 comments

Thank you for the article! I have been suffering from trigeminal neuralgia for a long time. NSAIDs help, but unfortunately relapses are common. Hands down.

Good afternoon everyone, I am writing for those who are desperate and have tried everything due to pain caused by the trigeminal nerve. All the information is on the Internet, I won’t write how I suffered for a whole year and went through everything, including tooth removal, a huge number of paid and free doctors in different fields, including unconventional methods of treatment, I spent a lot of money, nerves and effort to no avail. I understood one thing, and maybe this will help someone, if you haven’t done it yet or have done it, but you were told that this is not the cause of the pain - you need to do an MRI 3.0 of the brain (specifically for NEUROVASCULAR CONFLICT) and with the result, namely with a DISC , go for a consultation not just with a neurologist or neurosurgeon, but with a neurosurgeon who performs operations: MICROVASCULAR DECOMPRESSION OF THE TRIGEMINAL NERVE ROOT.

Because I went to see a neurosurgeon at an expensive clinic with the result, it was written that there was a conflict on the right, degree 1, and on the left, degree 2 (the 3rd strongest), it hurt on the right, i.e. Logically, the left side should also hurt, maybe even more, but it only hurt on the right side, the doctor said that I didn’t need surgery, continue with Finlipsin. But when a month later, quite by accident, I ended up at the Sverdlovsk Regional Oncology Center for a consultation, there they sent me to a neurosurgeon who does just such operations - for decompression, so he looked at the disk and said that the operation was necessary and it would help me, i.e. e. will completely relieve pain. In response to my question about the degrees, he said that on the right (where it hurts) the vein lies on the trigeminal root, but on the left it does not lie, I realized that all these degrees are different.

I agreed to the operation although I had a lot of doubts and it helped, I have not been taking Finlipsin for 2 months, after the operation it hurt a little, but it was different, the pain was tolerable and the headache was healing. I wanted to write this message later to wait a little longer to see what would happen, but I thought that someone was suffering and this information would lead to the right actions.

I am very grateful to the doctor that he saved me from this and made the right decision, and even when I was crying, he invited a patient with the same problem after the operation, he no longer had pain, I finally talked live with a person who had the same thing The same as for me, he (the patient) convinced me that I had to agree. Contact your place of residence where these operations are performed directly, because the same neurosurgeons specialize in certain operations.

I am from Yekaterinburg and had surgery with Pavel Borisovich Gvozdev, he has his own website, I came across it (the website) after the operation, this is for those who are from the Sverdlovsk region, the operation is free, I don’t know how they accept it from other regions. I think other doctors in this specialization will also help you. I will post this message on the forums where I tried to find an answer to my suffering.

Ekaterina, thank you very much. In my current situation, any help and advice is worth its weight in gold.

Trigeminal neuralgia: symptoms and treatment

Trigeminal neuralgia (Trousseau's pain tic, Fothergill's disease, trigeminal neuralgia) is a fairly common disease of the peripheral nervous system, the main symptom of which is paroxysmal, very intense pain in the area of ​​innervation (connection with the central nervous system) of one of the branches of the trigeminal nerve. The trigeminal nerve is a mixed nerve; it provides sensory innervation to the face and motor innervation to the masticatory muscles.

A wide variety of factors underlying the disease, excruciating pain, social and work maladjustment, long-term drug treatment with delayed treatment are not the entire range of reasons that keep this problem at the top of the ranking of neurological diseases. The symptoms of trigeminal neuralgia are quite easily recognizable even by non-professionals, but only a specialist can prescribe treatment. We will talk about this disease in this article.

Causes of trigeminal neuralgia

The trigeminal nerve is the 5th pair of cranial nerves. A person has two trigeminal nerves: left and right; The disease is based on damage to its branches. In total, the trigeminal nerve has 3 main branches: the ophthalmic nerve, the maxillary nerve, the mandibular nerve, each of which breaks up into smaller branches. All of them, on their way to the innervated structures, pass through certain openings and channels in the bones of the skull, where they can be subject to compression or irritation. The main reasons for this can be systematized as follows:

• congenital narrowing of the holes and canals along the branches;
• pathological changes in the vessels located next to the nerve (aneurysms, or protrusions of arterial walls, any abnormalities in vascular development, atherosclerosis) or their abnormal location (usually the superior cerebellar artery);
• cystic-adhesive processes in the area of ​​branches of the trigeminal nerve as a result of ocular, otorhinolaryngological, dental diseases (inflammation of the sinuses - frontal sinusitis, sinusitis, ethmoiditis; odontogenic periostitis, pulpitis, caries, iridocyclitis, etc.);
• metabolic disorders (diabetes mellitus, gout);
• chronic infectious diseases (tuberculosis, brucellosis, syphilis, herpes);
• tumors (any, localized along the nerve);
• hypothermia of the face (draft);
• facial and skull injuries;
• multiple sclerosis;
• rarely - brainstem stroke.

The pathological process can affect both the entire nerve and its individual branches. More often, of course, damage to one branch occurs, but in most cases, untimely treatment leads to progression of the disease and involvement of the entire nerve in the pathological process. There are several stages during the course of the disease. At a late stage (third stage of the disease), the clinical picture changes and the prognosis for recovery significantly worsens. Establishing the cause of the disease in each specific case allows you to most effectively select treatment and, accordingly, speed up healing.

Symptoms

The disease is more typical for middle-aged people, and is more often diagnosed. Females suffer more often than males. Damage to the right trigeminal nerve is most often observed (70% of all cases of the disease). Very rarely, trigeminal neuralgia can be bilateral. The disease is cyclical, that is, periods of exacerbation are followed by periods of remission. Exacerbations are more typical in the autumn-spring period. All manifestations of the disease can be divided into several groups: pain syndrome, motor and reflex disorders, vegetative-trophic symptoms.

Pain syndrome

Nature of the pain: the pain is paroxysmal and very intense, excruciating, sharp, burning. During an attack, patients often freeze and do not even move; they compare the pain to the passage of an electric current, or a shooting sensation. The duration of the paroxysm is from several seconds to several minutes, but during the day the attacks can be repeated up to 300 (!) times.

Localization of pain: pain can affect both the innervation zone of one of the branches and the entire nerve on one side (right or left). One of the features of the disease is the irradiation (spread) of pain from one branch to another, involving the entire half of the face. The longer the disease exists, the more likely it is to spread to other branches. Localization zones:

• optic nerve: forehead, anterior scalp, bridge of the nose, upper eyelid, eyeball, inner corner of the eye, mucous membrane of the upper part of the nasal cavity, frontal and ethmoid sinuses;
• maxillary nerve: upper part of the cheek, lower eyelid, outer corner of the eye, upper jaw and its teeth, wing of the nose, upper lip, maxillary sinus, mucous membrane of the nasal cavity;
• mandibular nerve: lower part of the cheek, chin, lower jaw and its teeth, lower surface of the tongue, lower lip, mucous membranes of the cheeks. The pain can radiate to the temple, back of the head, neck. Sometimes the pain is clearly localized in the area of ​​one tooth, which prompts patients to go to the dentist. However, treating this tooth does not eliminate the pain.

Provocation of pain: the development of pain paroxysm can be caused by touching or light pressure on the so-called trigger (trigger) zones. These zones are quite variable in each individual patient. Most often this is the inner corner of the eye, the back of the nose, the eyebrow, the nasolabial fold, the wing of the nose, the chin, the corner of the mouth, the mucous membrane of the cheek or gum. An attack can also be provoked by pressing on the exit points of the branches on the face: the supraorbital, infraorbital, and mental foramen. Pain can also be caused by talking, chewing, laughing, washing your face, shaving, brushing your teeth, applying makeup, even blowing wind.

Behavior during an attack: patients do not cry, do not scream, but freeze, trying not to move, rubbing the pain area.

Motor and reflex disorders:

• spasms of the facial muscles (hence the name of the disease “painful tic”): during a painful attack, involuntary muscle contraction develops in the orbicularis oculi muscle (blepharospasm), in the masticatory muscles (trismus), and in other facial muscles. Often muscle contractions extend to the entire half of the face;
• changes in reflexes - superciliary, corneal, mandibular - which is determined during a neurological examination.

Vegetative-trophic symptoms: observed at the time of the attack, in the initial stages they are slightly expressed, and as the disease progresses, they are necessarily accompanied by a painful paroxysm:

• skin color: local pallor or redness;
• changes in gland secretion: lacrimation, drooling, runny nose;
• late signs: develop with long-term existence of the disease. There may be swelling of the face, greasy or dry skin, and loss of eyelashes.

In the late stage of the disease, a focus of pathological pain activity forms in the visual thalamus (thalamus) in the brain. This leads to a change in the nature and location of pain. Eliminating the cause of the disease in this case no longer leads to recovery. The distinctive features of this stage of the disease are as follows:

• pain spreads to the entire half of the face from the onset of paroxysm;
• touching any part of the face causes pain;
• Even the memory of it can lead to a painful paroxysm;
• pain may occur in response to stimuli such as bright light or loud sound;
• the pain gradually loses its paroxysmal nature and becomes constant;
• vegetative-trophic disorders intensify.

Diagnostics

The main role in establishing a diagnosis belongs to carefully collected complaints and anamnesis of the disease. During a neurological examination, it is possible to identify areas of decreased or increased sensitivity on the face, as well as changes in the following reflexes:

• superciliary - that is, closing the eyes while tapping along the inner edge of the superciliary arch;
• corneal - that is, the effect of closing the eyes in response to external stimuli;
• mandibular - that is, contraction of the masticatory and temporal muscles when tapping on the lower jaw).

During the period of remission, a neurological examination may not reveal any pathology. To find the cause of neuralgia, the patient may be shown magnetic resonance imaging (MRI), but it does not always reveal the truth.

Treatment

The main methods of treating trigeminal neuralgia include:

• medicinal;
• physiotherapy;
• surgical treatment.

The main drug used in drug treatment remains carbamazepine (Tegretol). It has been used in the treatment of this disease since 1962. It is used according to a special scheme: the initial dose is mg/day, the dose is gradually increased and adjusted to mg/day in several doses. Once the clinical effect is achieved (cessation of painful attacks), the drug in a maintenance dose is used for a long time to prevent the occurrence of attacks, then the dose is also gradually reduced. Sometimes the patient has to take the drug for 6 months or more. Currently, oxcarbazepine (Trileptal) is also used, which has the same mechanism of action as carbamazepine, but is better tolerated.

In addition to carbamazepine, baclofen 5-10 mg 3 times a day (the drug should also be discontinued gradually) and amitriptyline mg/day are used to relieve pain. Of the new drugs synthesized in recent decades, gabapentin (gabagamma, tebantin) is used. When treating with gabapentin, it is also necessary to titrate the dose until it is clinically effective (the initial dose is usually 300 mg 3 times a day, and the effective dose is mg/day), followed by a stepwise reduction until the drug is discontinued. In order to relieve severe exacerbations, sodium hydroxybutyrate or diazepam can be used intravenously. Complex therapy uses nicotinic acid, trental, cavinton, phenibut, pantogam, glycine, B vitamins (milgamma, neurorubin).

Physiotherapeutic treatment is quite varied. Diadynamic currents, electrophoresis with novocaine, ultraphonophoresis with hydrocortisone, acupuncture, and laser therapy can be used. Physiotherapeutic techniques are used only in combination with drug treatment to achieve a faster and better effect.

In the absence of effect from conservative treatment, as well as in cases where trigeminal neuralgia is caused by compression of the root by an anatomical formation, surgical treatment methods are used:

• if the cause of compression is a pathologically altered vessel, then microvascular decompression is performed. The essence of the operation is to separate the vessel and the nerve using microsurgical techniques. This operation is highly effective, but very traumatic;
• percutaneous stereotactic rhizotomy: the nerve root is destroyed using an electric current supplied to the nerve using a needle in the form of an electrode;
• percutaneous balloon compression: stopping pain impulses along a nerve by compressing its fibers using a balloon brought to the nerve using a catheter;
• glycerin injections: destruction of the nerve using glycerin injections into the nerve branch sites;
• nerve destruction using ionizing radiation: non-invasive technique using radiation;
• radiofrequency ablation: destruction of nerve fibers using high temperature;
• If the cause is a tumor process, then, of course, removal of the tumor comes to the fore.

A characteristic feature of all surgical methods is a more pronounced effect when performed early. Those. The earlier this or that operation is performed, the higher the likelihood of cure. It should also be borne in mind that the disappearance of pain attacks does not occur immediately after surgical treatment, but somewhat remotely (the timing depends on the duration of the disease, the extent of the process and the type of surgical intervention). Therefore, all patients with trigeminal neuralgia need timely consultation with a doctor. Previously, the technique of injecting ethyl alcohol into the nerve branching sites was used. Such treatment often gave a temporary effect and had a high incidence of complications. As the nerve regenerated, the pain returned, so today this method of treatment is practically not used.

Prevention

Of course, it is not possible to influence all probable causes of the disease (for example, congenital narrowness of the canals cannot be changed). However, many factors in the development of this disease can be prevented:

• avoid hypothermia of the face;
• promptly treat diseases that can cause trigeminal neuralgia (diabetes mellitus, atherosclerosis, caries, sinusitis, frontal sinusitis, herpetic infection, tuberculosis, etc.);
• prevention of head injuries.

It should also be taken into account that methods of secondary prevention (i.e. when the disease has already manifested itself once) include high-quality, complete and timely treatment.

How is inflammation of the trigeminal nerve treated?

Treatment of inflammation of the trigeminal nerve (neuralgia) is carried out using various methods, but is it really possible to do this at home? We will try to answer in detail in today’s material.

This disease is insidious - pain symptoms overtake the victim suddenly and he will have to go a long way to get rid of them.

Description

So what is neuralgia and what are the problems of the disease? The trigeminal nerve is three branched nerves that run along both sides of the face: one of the branches is located above the eyebrows, the other two are on both sides of the nose and in the lower jaw.

Inflammation of this nerve is extremely painful and has a specific nature, the consequences of which are literally visible. When affected, pain appears in the forehead, nose, brow ridges, jaw, neck and chin. Severe attacks of toothache are possible. At the same time, nervous twitching, paleness or redness of the skin, and atrophy of the facial muscles also occur.

The disease occurs for various reasons - it can be independent or a consequence of various infections, overwork and stress. If you notice signs of neuralgia, you should not delay seeing a doctor and begin treatment as quickly as possible.

Types of inflammation

Since each part of the trigeminal nerve is divided into smaller branches that lead to all areas of the face, the nerve covers it as a whole. These branches are responsible for facial sensitivity.

The first branch is responsible for the eyebrow, eye, upper eyelid and forehead. The second - for the nose, cheek, lower eyelid and upper jaw, the third - for some chewing muscles and the lower jaw.

There are two types of disease:

• type one (true): the most common, occurs due to impaired blood supply or compression of a nerve, and is independent. In this type, the pain is severe, periodic and piercing;
• type two (secondary): a symptom, often a complication of a previous disease, arising as a result of complications of other diseases. With neuralgia of this type, the pain is burning and constant, and can occur in any part of the face.

Causes

Doctors are still unable to determine the exact factor why neuralgia occurs, but there are a number of reasons that contribute to the appearance and development of the disease:

• Compression of the trigeminal nerve can be internal or external. Tumors and adhesions formed after injuries, as well as a displacement of the location of arteries and veins near the trigeminal nerve are usually classified as internal. Inflammation in the oral cavity and nasal sinuses is classified as external factors;
• hypothermia of the face area - occurs among those who do not prefer to wear a hat in winter. If the nerve is cold, even washing with cold water can provoke an attack of neuralgia;
• signs of immune ailment of the body, against the background of which herpes has become more active - in this case, antiherpes drugs help;
• diseases of the oral area are an additional impetus for neuralgia: periodontitis, pulpitis, gingivitis, gum abscess, periodontitis and other types of caries complications are also very dangerous. If the filling is placed incorrectly (the material extends beyond the top of the tooth) or the patient is injured during tooth extraction, this can also be the cause;
• herpes zoster is a disease that is viral in nature and becomes more active if the body is weakened; as a result of reproduction, it develops an inflammatory process of the trigeminal nerve;
• “hunger” of the nerve - accumulation of cholesterol plaques on the walls of blood vessels.

To get rid of inflammation, you should take treatment:

• some forms of allergies;
• endocrine system disorders;
• metabolic failure;
• depression and insomnia;
• neurosis;
• cerebrovascular diseases;
• psychogenic disorders;
• multiple sclerosis;
• hepatic infection;
• reduced immune system.

The etiology of neuralgia is indeed wide, but it is generally accepted that it usually affects women aged 45 to 70 years. With age, immunity decreases and any physical activity can cause an attack of the disease.

Video: trigeminal neuralgia in the “Live Healthy” program with Elena Malysheva.

Symptoms of inflammation of the trigeminal nerve

Many patients complain of sudden and causeless pain, but also note the occurrence of neuralgia after stressful situations. Doctors are inclined to believe that the inflammation developed earlier - a stressful situation triggered the onset of pain.

The branches of the trigeminal nerve affect motor and sensory fibers, acute pain appears, spasms in the area of ​​the masticatory muscles, all these symptoms indicate inflammation.

Symptoms of facial nerve damage are:

• acute piercing pain in one of the halves of the face, which has a through nature;
• distorted facial expressions due to skewed individual areas or in the area of ​​one half of the face;
• headaches, chills, general weakness, muscle pain throughout the body;
• increased body temperature (hyperthermic reaction of the body);
• with severe pain - insomnia, fatigue and irritability;
• muscle twitching near the affected nerve;
• a small rash in the affected area of ​​a certain part of the face.

If the disease persists for a long time, paleness or redness of the skin, changes in the secretion of glands, greasy or dry skin, swelling of the face and even loss of eyelashes are possible.

Neuralgia pain is divided into two types:

1. Typical pain is sharp and intense, periodic, and can fade and recur. With neuritis, the shooting, similar to a toothache, resembles an electric shock and lasts about 2-3 minutes. It affects only one part of the face and is localized depending on which part of the triple nerve is damaged. After paroxysmal pain, it is replaced by aching pain.

Typical pain can be triggered by washing, brushing teeth, shaving, applying makeup - actions affecting one of the parts of the face. Pain appears during laughter, smiling and talking, most often occurring after exposure to low temperatures on one of the halves of the facial and ear areas.

Anatomy diagram, photo

The trigeminal nerve is located in the temporal zone, where its three branches are located and pass:

The first two branches have sensitive fibers, the last one has sensory and masticatory fibers, providing active muscular movements of the jaw.

Diagnostics

In diagnosing pathology, it is important to consult a doctor in time for an assessment of the pain syndrome and a neurological examination. The diagnosis is based on the patient’s complaints, the specialist determines the type of pain syndrome, its triggers, localization and possible places of damage that cause a pain attack.

To determine the affected area and find out which branch of the trigeminal nerve is damaged, the doctor palpates the patient’s face. Additionally, an examination is carried out for the presence of inflammatory processes in the facial area - sinusitis, sinusitis, frontal sinusitis.

The following instrumental research methods are used:

1. Magnetic resonance imaging is informative if the cause was sclerosis or a tumor.
2. Angiography - reveals dilated vessels or aneurysms of cerebral vessels that compress the nerve.

Treatment methods for trigeminal neuralgia

The disease is difficult to treat, and if painful attacks last more than a day, the patients are placed in the neurological department of the hospital. There, complex therapy is prescribed to prevent the development of the chronic form and relieve acute symptoms.

• electrophoresis and phonophoresis;
• ultrasound treatment;
• diadynamic therapy;
• acupuncture;
• treatment using impulsive low-frequency currents;
• laser processing;
• exposure to an electromagnet;
• infrared and ultraviolet treatment.

If the diagnosis is confirmed, then treatment of nerve inflammation begins with eliminating the main pain symptoms. In the future, the causes of the disease are determined (so that the treatment itself is not in vain), tests are prescribed and a full-scale examination of the patient is carried out.

• inflammatory processes in the sinuses, if any, are eliminated;
• when inflammatory processes are detected in the gums, great attention is paid to stopping them;
• if the patient has pulpitis, the nerve of the damaged tooth is removed, filling the root canals with filling material;
• If x-rays confirm that a filling is placed incorrectly on one of the teeth, it is re-treated.

To calm the pain, the patient is prescribed the necessary set of medications and referred to an appointment with an endocrinologist, immunologist, infectious disease specialist and allergist. If one of the specialists discovers a problem, they are prescribed appropriate medications.

Video: inflamed trigeminal nerve - how to identify symptoms and cure?

Medicines

You should not resort to self-medication for neuralgia without consulting a doctor who will select the necessary drug and its dosage.

1. Anticonvulsants: in the form of carbamazepine tablets (in other words - finlepsin, tegretol) - occupies a leading place in this category, providing an analgesic and anticonvulsant effect, inhibiting the activity of neurons, which eliminates pain. Due to its toxicity, it is not recommended for use by pregnant women; it can also lead to mental disorders, toxic damage to the liver and kidneys, drowsiness, nausea, and pancytopenia, among others. It is not recommended to drink grapefruit juice while taking it; it can aggravate the negative effects of the medicine on the body. Additionally, valproic acid drugs are prescribed: convulex, depakine, lamotrigine, diphenin (phenytoin), oxcarbazepine.
2. Painkillers and non-steroidal drugs: Nise, analgin, movalis or baralgin - taken after meals three times a day. The course of treatment is short-lived, since long-term use can cause problems with the gastrointestinal tract. They only help at the beginning of an attack. These include: dicloberl, revmoxib, movalis, indomethacin, celebrex.
3. Painkillers in the form of non-narcotic analgesics - in case of severe pain syndrome, dexalgin, ketanov, ketalgin and narcotic drugs are prescribed: promedol, morphine, tramadol, nalbuphine.
4. Antiviral drugs are prescribed if the neuritis is of a viral nature. Antibiotics are taken if the disease is bacterial in nature. The standards are acyclovir, herpevir, lavomax.
5. Neuroprotectors and vitamin preparations: neurorubin, thiogama, milgama, prozerin, nervohel and neurobion relieve nervousness, reducing the risk of an attack.
6. Glucocorticoids: reduce swelling, inflammation of the nerve, have a strong effect in a short time. Methylprednisolone, hydrocortisone, and dexamethasone are considered the best.

You also need to undergo mandatory physiotherapeutic treatment: paraffin-ozokerite, UHF, electrophoresis, magnetic therapy.

Surgical intervention

Surgical elimination of the cause of neuralgia is used in case of ineffectiveness of drug therapy or when pain persists.

There are two surgical methods:

• microvascular decompression;
• radiofrequency destruction;

The first method is trepanation of the posterior part of the cranial fossa. The trigeminal nerve root, which compresses the blood vessels, is separated. A special gasket is placed between the spine and the vessels to prevent compression to prevent relapses.

The radiofrequency destruction method is not so traumatic and is carried out under local anesthesia; current discharges are directed to the affected area, they also destroy the roots of the trigeminal nerve, which are susceptible to pathological processes.

Sometimes one operation is enough, otherwise the effect is repeated several times.

Massage

Massage for trigeminal neuritis increases tone and relieves excess muscle tension in certain muscle groups. Blood supply and microcirculation in the inflamed nerve and in the affected superficial tissues improve.

The impact on the reflex zones at the exit points of the branches of the trigeminal nerve of the facial, ear and cervical areas comes first in the massage, after which they work with the muscles and skin.

The massage is performed while sitting, leaning your head back on the headrest to relax the neck muscles. Attention is focused on the sternocleidomastoid muscle, thanks to light massaging movements. Then, with stroking and rubbing movements, they move up to the parotid areas, after which they massage the healthy and affected sides of the face.

The procedure lasts about 15 minutes, on average there are sessions per course of treatment.

How to treat at home?

The most effective folk remedies and recipes:

• chamomile - pour boiling water over 1 tsp. flowers. The drink is taken into the mouth and held there until the pain subsides at least a little;
• fir oil – you should rub it into the damaged areas throughout the day. The skin may become red, but the pain will subside. Three days of such procedures are enough;
• marshmallow - 4 tsp. The roots of the plant are poured with cooled boiled water, leaving for a day. In the evening, moisten a piece of cloth with the infusion and apply it to the face. The compress is insulated on top with a scarf or parchment paper, removed after an hour and a half, and a scarf is also worn at night;
• black radish - wipe the skin with its juice several times a day;
• buckwheat - a glass of cereal is well fried in a frying pan, then placed in a bag made of natural fabric, holding it on the affected areas until the buckwheat has cooled. Treatment is repeated 2-3 times a day;
• egg - cut a hard-boiled egg in half, applying its parts to the painful areas;
• raspberry - a vodka-based tincture is prepared from it by pouring the leaves of the plant (1 part) with vodka (3 parts), after which it is infused for 9 days, then this infusion is consumed for 90 days in a row in small doses before meals;
• clay - it is mixed with vinegar, after which thin plates are sculpted, which are applied every evening to the affected area;
• dates - several ripe products are ground in a meat grinder, this mass is consumed three times a day, 3 tsp. To improve the taste it is diluted with water or milk;
• ice - they wipe the skin of the face with it, covering the neck area, then warm the face, massaging it with warm fingers. At one time, the procedure is repeated for three approaches.

Important! We require that even traditional methods be used only under the supervision of a doctor. He will clarify the prescription and, moreover, will tell you whether treatment with such drugs will be effective specifically in your case.

Consequences

Inflammation of the trigeminal nerve is not fatal, but the consequences are very dangerous.

1. Depression is developing rapidly.
2. Constant pain causes mental disorders, there may be a need to avoid society, and social ties are broken.
3. The patient loses weight because he cannot eat properly.
4. The patient's immunity decreases.

Video: Fayyad Akhmedovich Farhat (Doctor of Medical Sciences, neurosurgeon of the highest qualification category) about a disease of the facial nerve.

Prevention

Since a common cause of inflammation of the trigeminal nerve is any disease of the paranasal sinuses (frontal sinusitis, sinusitis) or dental disease, premature therapy will greatly reduce the risk of the problem occurring.

• minimizing psycho-emotional stress;
• elimination of possible hypothermia;
• avoiding infectious diseases.

For viral and infectious diseases, anticonvulsants should be taken in parallel with antipyretic and antiviral drugs.

Additional questions

What to do if the trigeminal nerve hurts?

If the pain strikes suddenly, you should immediately consult a neurologist, who will determine the source of pain and methods for eliminating pain syndromes, prescribe the necessary medication or refer you to a neurosurgeon. Before going to the doctor, you can try to temporarily calm the pain using traditional methods of treatment.

Which doctor treats you?

A neurologist deals with the treatment of trigeminal neuralgia, and a neurosurgeon deals with surgical intervention on this basis.

In ICD-10 the disease is coded (G50.0).

Does double vision occur?

Double vision with neuralgia is quite real, often accompanied by hearing loss and noise in one of the ears.

Is it possible to heat inflammation of the trigeminal nerve?

The inflamed area should not be heated, even if relief occurs after this. Heat provokes the progression of inflammation, which can spread to other parts of the face.

Is acupuncture effective?

It is believed that acupuncture is really effective for this disease. It affects certain facial points according to special rules and techniques.

What should a pregnant woman do with this problem?

You need to see a doctor, he will take appropriate measures. Transcutaneous electrical stimulation, electrophoresis with a sanitary agent, and acupuncture during pregnancy are allowed.

In this article I would like to talk about what trigeminal neuralgia is and how to cope with this problem.

What it is?

At the very beginning, you need to decide on the concepts that will have to be used in this article.

1. Neuralgia is a dull, burning pain that occurs along the location of the nerve. Most often, people encounter not only trigeminal neuralgia, but also facial and intercostal neuralgia.
2. The trigeminal nerve is the most sensitive nerve of the face. Doctors distinguish the following branches of the trigeminal nerve:

• Branch 1: covers the forehead and everything above the brow ridge.
• Branch 2: wing of the nose, upper part of the lip, upper jaw.
• Branch 3: lower jaw, lower lip and chin.

Causes

What causes the pain that a person experiences when this nerve is inflamed? This occurs when an artery, nerve, and vein come into contact at the base of the skull, causing irritation. Why can the trigeminal nerve become inflamed? The reasons may be as follows:

1. Incorrectly located brain vessels can compress the nerve.
2. Problems with blood circulation in the vessels of the brain.
3. Brain tumors.
4. Hypothermia of the face and head.
5. Infection of certain areas of the face. Constant sinusitis and even caries can irritate the trigeminal nerve.
6. Multiple sclerosis. Since in this disease, nerve cells are periodically replaced by connective tissue.

Symptoms

By what signs can a diagnosis of “inflammation of the trigeminal nerve” be made? Symptoms of this disease are pain that can appear in any part of the face.

1. If the first branch is inflamed, the pain will be observed mostly in the eye area. “Give” will be to the temples, the root of the nose, the frontal lobe.
2. If the second branch is inflamed, pain will be concentrated mostly in the upper jaw area. The pain can “move” from the upper lip to the temple and back. It is also worth saying that this pain can easily be confused with a toothache.
3. If the third branch is inflamed, the pain is first felt in the chin, then it can spread to the lower jaw and ear.

Now it has become extremely clear how pain spreads if a person has inflammation of the trigeminal nerve. The symptoms of this disease can also be confused with the symptoms of other diseases, such as, for example, temporal tendonitis or dental problems. That is why, at the very first symptoms, it is important to seek medical help so that the correct diagnosis is made and proper treatment is prescribed.

Types of pain

Pain in this disease can be of two main types:

1. Typical pain. It may calm down from time to time. The character is shooting, reminiscent of an electric shock. Painful sensations occur when certain areas of the face are touched.
2. Unusual pain. Its character is constant, it affects most of the face. In this case, treatment is more difficult and lengthy.

A few more words about pain

It is worth saying that pain alone can make a diagnosis such as trigeminal neuralgia.

1. Most often the pain will be one-sided.
2. Its attacks may worsen with the advent of cold weather.
3. The frequency of painful attacks can be different: it varies from a couple of attacks per day to pain occurring every 10 minutes.
4. Duration of attacks: several seconds.
5. Pain can occur not only when touching your face, but also when brushing your teeth, chewing food, and even talking.
6. Most often it occurs suddenly.
7. Distributes along the branches of the trigeminal nerve.
8. Painful sensations may increase over time and become more frequent.

Diagnostics

How can a correct diagnosis of trigeminal neuralgia be made? Diagnosis of the disease should be carried out exclusively by a doctor. You can make a mistake in diagnosis on your own, and compare the symptoms with a completely different disease. What will the doctor do?

1. Neurological examination with pain assessment.
2. Palpation of the face. Necessary to determine the degree of damage to the trigeminal nerve.
3. MRI – magnetic resonance imaging.
4. Computer diagnostics.

Treatment

If a patient has trigeminal neuralgia, treatment of this disease can be carried out in various ways. So, it can be conservative, that is, medications and physical therapy can be prescribed. Treatment can also be radical. In this case, minimally invasive procedures are used, as well as surgery.

Conservative solution to the problem

As mentioned above, if the patient has trigeminal neuralgia, treatment can be conservative. What can the doctor prescribe in this case?

1. Antispasmodics. These are drugs that relieve pain, significantly alleviating the patient’s condition. These medications can be prescribed in isolation, but most often these medications are used together with anticonvulsants. Example: the drug “Baclofen” is prescribed together with the drug “Phenytoin” or “Carbamazepine”.
2. Anticonvulsant medications. To relieve pain associated with inflammation of the trigeminal nerve, doctors most often prescribe a drug such as Carbamazepine. You can also use other drugs of the same group: these can be drugs such as Lamotrigine or Gabapentin. The dosage of these drugs can be increased if necessary. However, this can only be done with the permission of the attending physician. It is also worth remembering that this can lead to side effects such as nausea, dizziness, loss of energy, and drowsiness.

Alcohol blockades

If the patient has an inflamed trigeminal nerve, treatment can be carried out using alcohol blockades. Their main goal: freezing the trigeminal nerve. After this, an analgesic effect occurs. With this treatment, the patient will be injected with the drug “Ethanol” into one of the branches of the trigeminal nerve. Relief occurs almost immediately, pain can disappear for a maximum of a day. However, then she still comes back. If the nerve damage is quite severe, the effect of these injections is not so long-lasting. The number of injections allowed varies depending on the degree of the disease and is prescribed exclusively by the doctor. This treatment also has its disadvantages. This method is fraught with the following complications:

1. Bleeding.
2. Hematomas.
3. Damage to blood vessels.
4. Damage to the nerve itself.

How will the process of alcohol blockade proceed if the patient has inflammation of the trigeminal nerve on the face? Medicines for neuralgia that the doctor may prescribe:

1. Conduction anesthesia. First, an injection of the drug “Novocaine” (2%) is given, dosage: 1-2 ml.
2. And only after this the doctor introduces several ml of 80% alcohol, always in combination with the drug Novocain.

It must be said that this procedure should be carried out exclusively on an outpatient basis, because it requires skills and abilities.

Surgery

How else can you get rid of such a problem as inflammation of the trigeminal nerve on the face? So, in some cases, the patient may be prescribed surgical intervention. What can the doctor do in this case?

1. “Free” the nerve from the pressure of the vessel on it.
2. The trigeminal nerve itself or its node may be destroyed. This is done in order to relieve pain.

It is worth saying that such operations are minimally invasive.

Bloodless surgery

If the patient has trigeminal neuralgia, treatment can be carried out using radiosurgery such as cyberknife or gamma knife.

1. Gamma Knife. An innovative tool in radiosurgery. During this intervention, the patient puts a special helmet on his head. Gamma radiation is directed to the pathological focus and thus relieves the patient of the problem.
2. Cyber ​​knife. In this case, treatment is also carried out with a weak dose of radiation, but here a helmet is not worn. With this procedure, a emitting head works, which itself finds the pathological focus and “removes” it.

There are many advantages of this method of treatment. First of all, this is a non-invasive intervention. This eliminates the risk of bleeding and other complications that may occur during a conventional operation. Also, the patient does not require hospitalization, there is no preoperative preparation. It is also important that anesthesia is not required. And one more huge advantage of this method of treatment: there is no postoperative period. After the procedure, the patient can immediately return to their daily activities.

Other ways to combat this disease

If the patient has trigeminal neuralgia, treatment can be carried out in the following ways:

1. Vascular decompression. In this case, during surgery the patient will be “freed” the nerve. Doctors can either displace or remove the vessel itself. This procedure can be performed if the patient has an abnormal placement of blood vessels in the cranial cavity. However, after such an intervention, a return of the pain syndrome is still possible. In addition, complications such as facial numbness, double vision, hearing loss and even stroke are also possible.
2. Balloon compression. In this procedure, the doctor inserts a catheter into the trigeminal nerve ganglion, at the tip of which a small balloon is placed. It gradually inflates, causing the nerve to burst. This treatment is carried out using CT or MRI. A caveat: after these actions, the disease may return. Complications such as partial numbness of the face or weakness of the masticatory and facial muscles may also occur.
3. If the patient's trigeminal nerve is affected, treatment can be achieved through a procedure such as rhizotomy. This is the intersection of the nerve that is responsible for pain. In this case, frequency rhizotomy is possible, when only the edge of the nerve is destroyed under local anesthesia. But radiofrequency trigeminal rhizotomy is also possible, when the doctor inserts a special needle under the base of the skull. A small impulse is applied to it, which leads to the destruction of the nerve. It is worth saying that this method is used most often in the treatment of elderly people, as well as patients with multiple sclerosis. The effect of this procedure lasts quite a long time. Pain may take at least a few years to appear.

ethnoscience

If a patient is diagnosed with trigeminal neuralgia, drug treatment is not the only way to get rid of this problem. You can also try to cure yourself with various folk remedies.

1. To prepare the medicine, you need to chop the onion, potatoes and pickled cucumber, pour everything with diluted wine vinegar until it becomes a paste. The resulting mass should be left for about 2 hours. At this time, you must remember that the medicine must be shaken. It is best to do this every 15 minutes. And only after this can you be treated with this remedy. Compresses are made from it, which are placed on the affected areas of the face twice a day - morning and evening. The compress is kept on the face for 1 hour.
2. If a patient has inflammation of the trigeminal facial nerve, juice obtained from black radish can be used for treatment. You just need to rub it along the nerve into the skin. This must be done three times a day.
3. You can also prepare a medicinal infusion. To do this, you need to pour one tablespoon of yarrow herb with a glass of boiling water. Then everything is infused for at least 1 hour and filtered. The medicine should be taken one tablespoon three times a day 10 minutes before main meals.
4. If the trigeminal nerve is inflamed, treatment can be carried out using fir oil. It must be rubbed into the skin about 6 times a day. It is best to use a cotton pad for this. Do not be alarmed if the skin at the site of rubbing turns red and swells. The pain will soon subside, the burn will go away, and the problem will not bother you.
5. People say that regular boiled eggs help relieve pain. If the patient has an inflamed trigeminal nerve, you need to hard-boil one egg, peel it, cut it in half and apply it to the skin in the places where the pain is localized. Soon the disease will disappear.
6. Regular chamomile tea can help relieve pain. It is very simple to prepare: pour 1 teaspoon of the herb with a glass of boiling water and leave for a little while. The medicine is ready. Now you need to take the tea into your mouth and keep it there for a long time.

Trigeminal neuralgia

Trigeminal neuralgia is a chronic disease that occurs with exacerbations and remissions. A characteristic sign of the disease is attacks of intense shooting pain in the innervation zones of the II, III or, less commonly, I branch of the trigeminal nerve. The concept of “trigeminal neuralgia” also corresponds to: Fothergill’s disease, painful tic, trigeminal neuralgia. Trigeminal neuralgia can be idiopathic or symptomatic (secondary). The basis of treatment for trigeminal neuralgia is the use of anticonvulsants (carbamazepine, phenytoin). Along with this, symptomatic treatment and physiotherapy are carried out.

Trigeminal neuralgia

Trigeminal neuralgia is a chronic disease that occurs with exacerbations and remissions. A characteristic sign of the disease is attacks of intense shooting pain in the innervation zones of the II, III or, less commonly, I branch of the trigeminal nerve. The concept of “trigeminal neuralgia” also corresponds to: Fothergill’s disease, painful tic, trigeminal neuralgia. There are two types of trigeminal neuralgia: primary (idiopathic) and secondary (symptomatic).

Etiology and pathogenesis of trigeminal neuralgia

Idiopathic trigeminal neuralgia in most cases is caused by compression of the trigeminal nerve root in the area of ​​its entry into the brain stem (as a consequence of a pathologically tortuous loop of the superior cerebellar artery). Therefore, if during a neurosurgical operation a patient is found to have compression of a nerve root by a pathologically tortuous blood vessel, secondary trigeminal neuralgia is diagnosed. However, most patients do not undergo neurosurgical operations and, despite assumptions about the compressive nature of neuralgia, they designate it with the term “primary trigeminal neuralgia,” and the diagnosis “secondary trigeminal neuralgia” is made if pathological processes other than compression.

The pathogenesis of trigeminal neuralgia is traditionally explained in terms of the “pain control gate” theory of Melzack and Wall, which is based on the assertion that fast-conducting, well-myelinated type A fibers and unmyelinated C fibers compete. Neuralgia of the V and IX pairs of the CN are caused by compression of their roots in the area of ​​entry into the brain stem. Demyelination of A fibers is accompanied by the appearance of a large number of additional voltage-dependent sodium channels in the demyelinated areas and the formation of contacts of these areas with type C fibers. As a result of these processes, prolonged and high-amplitude activity of pathologically altered A fibers is formed, which manifests itself in the form of painful paroxysms in the facial area ( oral cavity).

Clinical picture and diagnosis

The clinical picture of an attack of trigeminal neuralgia has characteristic signs and therefore diagnosing the disease does not present difficulties for a neurologist. So, typical signs of pain syndrome with trigeminal neuralgia:

• twitching of the chewing or facial muscles at the peak of a painful attack

In some cases, secondary fascial prosopalgic syndrome may develop. All patients diagnosed with trigeminal neuralgia, both during periods of exacerbation and during remission, use the healthy half of the mouth for chewing, as a result of which muscle compactions are formed in the contralateral part of the mouth (most often the posterior belly of the digastric muscle and the pterygoid muscles). In some cases, auscultation of the temporomandibular joint reveals a characteristic crunch. With a prolonged course of the disease, a dystrophic stage may develop, manifested by moderate atrophy of the masticatory muscles and decreased sensitivity on the affected half of the face.

The clinical manifestations of symptomatic trigeminal neuralgia do not differ from the clinical picture of idiopathic neuralgia, typical signs of which are increasing sensory deficits in the area of ​​innervation of the corresponding branch, the absence of refractory periods and other focal symptoms of damage to the brain stem or adjacent CN (ataxia, nystagmus).

In addition to the above-described forms of neuralgia, neuralgia of individual branches of the trigeminal nerve is distinguished. Nasociliary neuralgia (Charlen's neuralgia) is a rare disease characterized by a stabbing pain radiating to the forehead that occurs when the outer surface of the nostril is touched. Supraorbital neuralgia is as rare a disease as nasociliary neuralgia. A characteristic clinical sign of the disease is paroxysmal or constant pain in the area of ​​the supraorbital notch and the medial part of the forehead (the area of ​​innervation of the supraorbital nerve). Neuralgia of other branches of the trigeminal nerve is possible - infraorbital, lingual, alveolar, buccal nerves, as well as “tic-neuralgia” (a combination of neuralgia of the first branch of the trigeminal nerve and periodic migraine neuralgia).

Postherpetic neuralgia is a disease that occurs as a result of decreased immunity in old age. A characteristic clinical sign is persistent or recurrent facial pain (prosopalgia) that occurs for 3 or more months after the onset of Herpes zoster infection.

The basis of treatment for trigeminal neuralgia is the drug carbamazepine, the dose of which is selected individually for each patient. By reducing the amplitude of potentials in the sensitive nuclei of the spinal and diencephalon, it disrupts the perception of external stimuli (including painful ones). In most cases, 1-2 days after taking the drug, patients feel its analgesic effect, the duration of which, as a rule, is from 3 to 4 hours. When prescribing carbamazepine, you should remember about contraindications to its use (glaucoma, epileptic seizures, bone marrow pathology). In case of ineffectiveness (or low effectiveness) of carbamazepine, another anticonvulsant drug is prescribed - phenytoin, which also has a number of contraindications (kidney disease, liver disease, heart failure).

The dose of carbamazepine, which allows patients to eat and talk painlessly, should remain unchanged for one month, after which it should be gradually reduced. Carbamazepine therapy continues for several months/years and is stopped only if there is complete freedom from attacks for 6 months. Antihistamines (diphenhydramine, promethazine), antispasmodics, and microcirculation correctors (nicotinic acid, pentoxifylline) can enhance the therapeutic effect of carbamazepine. Physiotherapeutic methods for the treatment of trigeminal neuralgia are also used: galvanization with amidopyrine or novocaine, ultraphonophoresis with hydrocortisone and diadynamic currents.

The ineffectiveness of drug treatment is an indication for surgical intervention - microsurgical decompression of the branches of the trigeminal nerve in the area of ​​their exit from the brain stem is performed. However, one should remember the high risk of performing such an operation in elderly patients, as well as in cases where trigeminal neuralgia is accompanied by severe somatic pathology. Recently, the most common treatment for trigeminal neuralgia is the method of percutaneous radiofrequency destruction of the trigeminal nerve roots. Completely new bloodless methods for treating trigeminal neuralgia are also being developed. For example, the so-called “gamma knife” - stereotactic radiosurgical destruction of a sensory root with local gamma radiation.

Forecast and prevention of trigeminal neuralgia

The optimistic prognosis for trigeminal neuralgia is determined by the cause that caused the development of neuralgia and the age of the patient. Trigeminal neuralgia in a young patient caused by facial trauma is usually easy to treat and does not recur in the future. However, in old age, trigeminal neuralgia, accompanied by metabolic disorders in the body, cannot always be cured.

Often the cause of the development of trigeminal neuralgia is some disease of the teeth or paranasal sinuses (frontal sinusitis, sinusitis). Adequate and timely treatment of these diseases reduces the risk of trigeminal neuralgia. Prevention of exacerbations of trigeminal neuralgia involves minimizing psycho-emotional stress, possible hypothermia, and infectious diseases. For infectious and viral diseases, along with antiviral and antipyretic drugs, it is necessary to take anticonvulsants.

Trigeminal neuralgia - treatment, causes, symptoms, first signs

Trigeminal neuralgia is a fairly common disease of the peripheral nervous system, the main symptom of which is paroxysmal, very intense pain in the area of ​​innervation (connection with the central nervous system) of one of the branches of the trigeminal nerve.

Trigeminal neuralgia does not go away painlessly; it is a rather serious illness. This disease most often affects older women. In some cases, even surgery is required.

What is neuralgia, types of disease

The trigeminal nerve originates from the trunk of the anterior part of the pons, located next to the middle cerebellar peduncles. It is formed from two roots - a large sensory root and a small motor one. Both roots from the base are directed to the apex of the temporal bone.

The motor root, together with the third sensory branch, exits through the foramen ovale and further connects with it. In the depression at the level of the upper part of the pyramidal bone there is a semilunar node. Three main sensory branches of the trigeminal nerve emerge from it (see photo).

Neuralgia in translation means pain along the nerve. Having 3 branches, the trigeminal nerve is responsible for the sensitivity of one side of the face and innervates strictly defined areas:

• 1 branch - orbital region;
• 2nd branch - cheek, nostril, upper lip and gum;
• 3rd branch - lower jaw, lip and gum.

All of them, on their way to the innervated structures, pass through certain openings and channels in the bones of the skull, where they can be subjected to compression or irritation. Neuralgia of the 1st branch of the trigeminal nerve is extremely rare; most often the 2nd and/or 3rd branches are affected.

If one of the branches of the trigeminal nerve is affected, a variety of disorders may occur. For example, the area of ​​innervation may become insensitive. Sometimes, on the contrary, it becomes too sensitive, almost to the point of being painful. Often part of the face seems to sag or becomes less mobile.

Conventionally, all types of trigeminal neuralgia can be divided into primary (true) and secondary neuralgia.

1. Primary (true) neuralgia is considered a separate pathology that occurs as a result of compression of the nerve or impaired blood supply in this area.
2. Secondary neuralgia is the result of other pathologies. These include tumor processes and severe infectious diseases.

Causes

The exact cause of the development of trigeminal neuralgia is not clear; as mentioned above, it is an idiopathic disease. But there are factors that most often lead to the development of this disease.

The reasons for the development of trigeminal neuralgia are varied:

• compression of the nerve in the area of ​​its exit from the cranial cavity through the bone canal with an abnormal arrangement of cerebral vessels;
• aneurysm of a vessel in the cranial cavity;
• metabolic disorders: gout, diabetes, thyroid diseases and other endocrine pathologies;
• hypothermia of the face;
• chronic infectious diseases in the facial area (chronic sinusitis, dental caries);
• metabolic disorders (diabetes mellitus, gout);
• chronic infectious diseases (tuberculosis, brucellosis, syphilis, herpes);
• mental disorders;
• suppuration of the bones of the skull, especially the jaws (osteomyelitis);
• severe allergic diseases;
• helminthiasis (worms);
• multiple sclerosis;
• brain tumors.

Symptoms of trigeminal neuralgia

The disease is more typical for middle-aged people, and is more often diagnosed. Females suffer more often than males. Damage to the right trigeminal nerve is most often observed (70% of all cases of the disease). Very rarely, trigeminal neuralgia can be bilateral. The disease is cyclical, that is, periods of exacerbation are followed by periods of remission. Exacerbations are more typical in the autumn-spring period.

So, typical signs of pain syndrome with trigeminal neuralgia:

• the nature of the pain in the face is shooting, extremely hard; patients often compare it to an electric shock
• Duration of an attack of neuralgia - seconds (no more than two minutes)
• the presence of a refractory period (the interval between attacks)
• localization of pain - does not change for several years
• pain of a certain direction (from one part of the face goes to another)
• the presence of trigger zones (areas of the face or oral cavity, irritation of which causes a typical paroxysm)
• the presence of trigger factors (actions or conditions under which a painful attack occurs; for example, chewing, washing, talking)
• The characteristic behavior of the patient during an attack is the absence of crying, screaming and a minimum of movements.
• twitching of the chewing or facial muscles at the peak of a painful attack.

Among the secondary symptoms of trigeminal neuralgia, phobic syndrome should be distinguished. It is formed against the background of “protective behavior,” when a person avoids certain movements and postures so as not to provoke an exacerbation of the disease.

1. Chewing food with the side opposite the painful side;
2. Neuropathic complications of neuralgia lead to secondary pain in the head;
3. Concomitant irritation of the auditory and facial nerves.

Symptoms are difficult to interpret correctly if the patient’s pain syndrome is mild.

Due to the fact that all patients suffering from trigeminal neuralgia use only the healthy half of the mouth for chewing, muscle compactions form on the opposite side. With a long course of the disease, dystrophic changes in the masticatory muscles and a decrease in sensitivity on the affected side of the face may develop.

Localization of pain

Painful attacks may not be isolated, but follow each other at short intervals. The pathogenesis of the development of trigeminal neuralgia is very diverse:

1. Usually, unpleasant sensations in any part of the face manifest themselves in the form of an attack.
2. The pain numbs the person for a couple of minutes and temporarily subsides. Then he comes again. Between painful attacks it takes from 5 minutes to an hour.
3. The defeat is reminiscent of being hit with a stun gun. Discomfort is usually localized in one part of the face, but often the patient feels pain in several places at once.
4. It seems to a person that the pain covers the entire head, eye area, ears, nose. It is very difficult to speak during an attack.
5. The pain that cramps the oral cavity makes it extremely difficult to pronounce words. This may cause severe muscle twitching.

Other diseases are similar to the symptoms of trigeminal neuralgia. These include temporal tendonitis, Ernest's syndrome and occipital neuralgia. With temporal tendonitis, pain affects the cheek and teeth, headache and pain in the neck.

With occipital neuralgia, pain is usually located in front and behind the head and can sometimes spread to the face.

What most often causes pain in trigeminal neuralgia?

If the patient has neuralgia, then each attack occurs due to irritation of the trigeminal nerve, due to the existence of trigger, or “trigger” zones. They are localized on the face: in the corners of the nose, eyes, nasolabial folds. With irritation, sometimes extremely weak, they can begin to “generate” a stable, long-lasting painful impulse.

Factors causing pain may be:

1. shaving procedure for men. Therefore, the appearance of a patient with a shaggy beard may lead an experienced doctor to “experienced neuralgia”;
2. just a light stroke of the face. Such patients protect their face very carefully and do not use a handkerchief or napkin.
3. the process of eating, the procedure of brushing teeth. Movements of the muscles of the oral cavity, cheek muscles and pharyngeal constrictors provoke pain as the facial skin begins to shift;
4. fluid intake process. One of the painful conditions, since quenching thirst is punished by severe pain;
5. an ordinary smile, as well as crying and laughing, talking;
6. applying makeup to the face;
7. sensation of pungent odors, which are called “trigeminal” - acetone, ammonia.

Consequences of neuralgia for humans

Trigeminal neuralgia in an advanced state entails certain consequences:

• paresis of facial muscles;
• hearing impairment;
• paralysis of facial muscles;
• development of facial asymmetry;
• prolonged pain;
• damage to the nervous system.

The risk group consists of older people (usually women), people suffering from cardiovascular diseases or metabolic disorders.

Diagnostics

A neurologist needs to differentiate frontal sinusitis, glaucoma, dental diseases, otitis, mumps, ethmoiditis or sinusitis. For this, a comprehensive examination is prescribed.

Typically, the diagnosis of trigeminal neuralgia is made based on the patient’s complaints and examination. Magnetic resonance imaging is important in diagnosing the cause of neuralgia. It allows you to identify a tumor or signs of multiple sclerosis.

Basic diagnostic methods:

1. Consultation with a neurologist. Based on the results of the initial examination, the doctor determines further types of examination.
2. Dental examination. Neuralgia often occurs against the background of dental diseases and poor-quality dentures.
3. Panoramic x-ray of the skull and teeth. Helps to see formations that could be pinching a nerve.
4. MRI. The study helps to see the structure of nerves, the presence and localization of vascular pathologies, and various types of tumors.
5. Electromyography is designed to study the characteristics of the passage of impulses along a nerve.
6. Blood test - allows you to exclude the viral origin of pathological changes in the trigeminal nerve.

If you have been diagnosed with neuralgia, do not be alarmed; in general, the prognosis is favorable, but timely treatment plays an important role.

Treatment of trigeminal neuralgia

It is extremely difficult to cure this disease and even radical treatment methods do not always give a positive result. But proper therapy can relieve pain and significantly alleviate human suffering.

The main treatment methods for trigeminal neuralgia include:

• medicinal;
• physiotherapy;
• surgical treatment.

Medications

Various groups of drugs are used in drug treatment, including:

• Anticonvulsants
• Antispasmodics and muscle relaxants.

Before using any drug, consultation with a neurologist is necessary.

Finlepsin for trigeminal neuralgia is one of the most common anticonvulsants. The active ingredient of this drug is carbamazepine. This drug plays the role of an analgesic for idiopathic neuralgia or a disease that occurs against the background of multiple sclerosis.

In patients with trigeminal neuralgia, Finlepsin stops the onset of pain attacks. The effect is noticeable 8 – 72 hours after taking the drug. The dosage is selected only by the doctor individually for each patient.

The dose of Finlepsin (carbamazepine), with which patients can talk and chew painlessly, should remain unchanged for a month, after which it should be gradually reduced. Therapy with this drug can last until the patient notes the absence of attacks for six months.

Other drugs for trigeminal neuralgia:

Each of these drugs has indications for use in trigeminal neuralgia. Sometimes these drugs do not help, so phenytoin is prescribed at a dose of 250 mg. The drug has a cardiodepressive effect, so it should be administered slowly.

Physiotherapeutic procedures

Physiotherapeutic procedures include paraffin baths, the use of various types of currents, and acupuncture. To get rid of severe pain, doctors give the patient alcohol-novocaine blockades. This is enough for some time, but the blockades are less and less effective each time.

• The following methods are used:
• Acupuncture;
• Magnetotherapy;
• Ultrasound;
• Laser treatment;
• Electrophoresis with drugs.

Surgical treatment of trigeminal neuralgia

During surgical treatment, the doctor tries to eliminate the compression of the nerve trunk by the blood vessel. In other cases, the trigeminal nerve itself or its node is destroyed in order to relieve pain.

Surgical treatments for trigeminal neuralgia are often minimally invasive. In addition, the surgical method also includes the so-called. Radiosurgery is a bloodless intervention that does not require any incisions or stitches.

There are the following types of operations:

1. Percutaneous surgery. Used in the early stages of the disease. Under local anesthesia, the trigeminal nerve is destroyed by exposing it to chemicals or radio waves.
2. Nerve decompression. This operation is aimed at correcting the location of the arteries that compress the trigeminal nerve.
3. Radiofrequency destruction of the nerve root. In this operation, only a certain part of the nerve is destroyed.

The type of operation is prescribed depending on the individual characteristics of the patient’s disease.

A characteristic feature of all surgical methods is a more pronounced effect when performed early. Those. The earlier this or that operation is performed, the higher the likelihood of cure.

Folk remedies for use at home

How to treat neuralgia with folk remedies? When using folk remedies, it is important to remember that only symptoms are relieved in this way. Of course, first of all, you should use folk recipes that can effectively help fight the inflammatory process.

It is important to remember that the use of a particular treatment method should be discussed with a doctor. Pay attention to the consequences that drug treatment may bring.

Folk remedies for treating neuralgia at home:

1. Birch juice. By taking it orally or lubricating it on the side of the face affected by neuralgia, you can reduce the symptoms of the disease. You need to drink 4-5 glasses of this juice per day.
2. The beets are grated on a coarse grater. A small envelope is made from the bandage (the bandage is rolled up in several layers), into which the grated beets are placed. Such a bundle is inserted into the ear canal from the side where the inflammation appears.
3. Black radish juice will also help. It can be mixed with lavender tincture or lavender essential oil and rubbed into the sore spot. Then you should wrap yourself in a scarf and lie there for half an hour. During an attack, it is permissible to fumigate the room in which the patient is located. For this you need a wormwood cigar. It is rolled from dry wormwood leaves and set on fire. Fumigation should last no more than 7-10 minutes. Such manipulations must be carried out within a week.
4. Heat a glass of buckwheat in a frying pan, pour the cereal into a cotton bag and apply to the sore area. The bag is removed when it has completely cooled down. This procedure is carried out twice a day.
5. We treat trigeminal neuralgia with pharmaceutical chamomile - an excellent sedative for NTN. You can make morning tea from it. You should take a certain amount of warm drink into your mouth, but do not swallow it, but hold it for as long as possible.
6. Grate the horseradish root on a coarse grater, wrap the resulting pulp in a napkin and apply it as a lotion to the affected area.
7. To relieve tension in the body and relieve neuralgic pain, hot baths with the addition of a decoction of young aspen bark are recommended.

Prevention

Of course, it is not possible to influence all probable causes of the disease (for example, congenital narrowness of the canals cannot be changed). However, many factors in the development of this disease can be prevented:

• avoid hypothermia of the face;
• promptly treat diseases that can cause trigeminal neuralgia (diabetes mellitus, atherosclerosis, caries, sinusitis, frontal sinusitis, herpetic infection, tuberculosis, etc.);
• prevention of head injuries.

It should also be taken into account that methods of secondary prevention (i.e. when the disease has already manifested itself once) include high-quality, complete and timely treatment.

So, getting rid of ternary neuralgia is possible. You just need to seek help from specialists in time and undergo an examination. The neurologist will immediately prescribe the necessary medications to combat the disease. If such remedies do not help in the fight against trigeminal neuralgia, they resort to the help of a neurosurgeon who solves the problem surgically.

Discussion: 6 comments

Thank you for the article! I have been suffering from trigeminal neuralgia for a long time. NSAIDs help, but unfortunately relapses are common. Hands down.

Good afternoon everyone, I am writing for those who are desperate and have tried everything due to pain caused by the trigeminal nerve. All the information is on the Internet, I won’t write how I suffered for a whole year and went through everything, including tooth removal, a huge number of paid and free doctors in different fields, including unconventional methods of treatment, I spent a lot of money, nerves and effort to no avail. I understood one thing, and maybe this will help someone, if you haven’t done it yet or have done it, but you were told that this is not the cause of the pain - you need to do an MRI 3.0 of the brain (specifically for NEUROVASCULAR CONFLICT) and with the result, namely with a DISC , go for a consultation not just with a neurologist or neurosurgeon, but with a neurosurgeon who performs operations: MICROVASCULAR DECOMPRESSION OF THE TRIGEMINAL NERVE ROOT.

Because I went to see a neurosurgeon at an expensive clinic with the result, it was written that there was a conflict on the right, degree 1, and on the left, degree 2 (the 3rd strongest), it hurt on the right, i.e. Logically, the left side should also hurt, maybe even more, but it only hurt on the right side, the doctor said that I didn’t need surgery, continue with Finlipsin. But when a month later, quite by accident, I ended up at the Sverdlovsk Regional Oncology Center for a consultation, there they sent me to a neurosurgeon who does just such operations - for decompression, so he looked at the disk and said that the operation was necessary and it would help me, i.e. e. will completely relieve pain. In response to my question about the degrees, he said that on the right (where it hurts) the vein lies on the trigeminal root, but on the left it does not lie, I realized that all these degrees are different.

I agreed to the operation although I had a lot of doubts and it helped, I have not been taking Finlipsin for 2 months, after the operation it hurt a little, but it was different, the pain was tolerable and the headache was healing. I wanted to write this message later to wait a little longer to see what would happen, but I thought that someone was suffering and this information would lead to the right actions.

I am very grateful to the doctor that he saved me from this and made the right decision, and even when I was crying, he invited a patient with the same problem after the operation, he no longer had pain, I finally talked live with a person who had the same thing The same as for me, he (the patient) convinced me that I had to agree. Contact your place of residence where these operations are performed directly, because the same neurosurgeons specialize in certain operations.

I am from Yekaterinburg and had surgery with Pavel Borisovich Gvozdev, he has his own website, I came across it (the website) after the operation, this is for those who are from the Sverdlovsk region, the operation is free, I don’t know how they accept it from other regions. I think other doctors in this specialization will also help you. I will post this message on the forums where I tried to find an answer to my suffering.

Ekaterina, thank you very much. In my current situation, any help and advice is worth its weight in gold.

Trigeminal neuralgia

Trigeminal neuralgia is a symptom complex manifested by attacks of excruciating pain localized in the zone of innervation of one or more branches of the trigeminal nerve. This is the most common of all types of neuralgia.

Neurostomatologists distinguish between neuralgia with a predominantly central or peripheral component of pathogenesis (central or peripheral origin). That is, there are forms of diseases whose development is based on a central component, for example, neuralgia due to circulatory disorders in the trigeminal nerve nucleus, or a peripheral component as a consequence of the impact of the pathological process on various parts of the peripheral part of the trigeminal nerve (tumors localized near the trigeminal nerve in the posterior or middle cranial fossa, basal meningitis, diseases of the paranasal sinuses, dental system, malocclusion, facial trauma, etc.). There is no doubt the importance in the origin of trigeminal neuralgia of peripheral origin of the compression (tunnel) factor - compression of the nerve root by pathological formations, more often due to the expansion or dislocation of loop-shaped vessels (usually the superior or anterior inferior cerebellar arteries) with the development, as a rule, of focal demyelination, as well as congenital or acquired narrowing of the infraorbital canal due to thickening of its walls (excess osteogenesis leading to hyperostosis) as a result of local chronic inflammatory processes, most often odontogenic and rhinogenic. Chronic irritation of the branches of the trigeminal nerve is possible with an aneurysm of the vessels of the base of the brain, tumors and cysts of the maxillary sinus, osteoma of the frontal bone, dental diseases, purulent sinusitis, tumors of the trigeminal nerve ganglion. The greatest vulnerability of the first and second branches of the trigeminal nerve (ophthalmic and maxillary nerves) is apparently due to their passage through narrow and long bone canals. A provoking factor can be infection (flu, malaria, syphilis, etc.), hypothermia, intoxication (lead, alcohol, nicotine), etc.

The primary link in pathogenesis is, as a rule, damage to the peripheral segment of the nerve. Under the influence of the compression factor and prolonged subcortical stimulation from the periphery, an algogenic system is formed in the brain, which is stable, highly excitable and responds to any afferent impulses with paroxysmal-type excitation. A unified idea has been created about the mechanisms underlying the disease - this is a multineuronal reflex involving, as a result of long-term pathological impulses from the periphery, both specific and nonspecific structures of the brain stem, subcortical formations and the cerebral cortex.

With trigeminal neuralgia, a complex interaction of organic and functional, peripheral and central changes occurs.

The role of compression of the peripheral branches of the trigeminal nerve has become more clear in the light of the “gate” theory of pain. It has been established that the pain syndrome in this pathology is associated with the selective death of thick myelin fibers, responsible for the rapid conduction of clearly localized pain and the inclusion of a “trigger” of central control - the antinociceptive systems of the brain stem, and the proliferation of thin non-myelin fibers, characterized by the slow conduction of vaguely localized (protopathic) pain. pain. Evidence of the formation of a focus of pathological activity in the central nervous system is increased pain with irritation of the auditory and optic nerves and negative emotions. Clinical manifestations of the disease occur when there is a violation of the relationship between the pain focus and antinociceptive structures at the level of the midbrain and diencephalon, which explains the high incidence of the disease in individuals with vascular pathology of the brain, in which the oral parts of the brain stem are affected relatively often and early.

The debate about whether trigeminal neuralgia is a functional or structural disease has already ended. Experimental and clinical studies have proven that after the onset of the disease, structural changes in the form of swelling, fragmentation and vacuolization are detected in the axial cylinders of the affected branch of the trigeminal nerve, which progress during the course of the disease and in its later stages turn into granular disintegration. The central mechanisms of pain paroxysm are activated secondarily under the influence of pathological afferentation from the periphery.

Thus, the idea of ​​the formation of foci of paroxysmal activity of brain neurons due to irritation of brain structures with a decrease in the threshold of excitation of cortical-subcortical structures under the influence of endocrine metabolic factors, circulatory disorders and immunological changes in trigeminal neuralgia is justified.

Trigeminal neuralgia is predominantly of central origin. The etiology and pathogenesis of trigeminal neuralgia of predominantly central origin have not been fully elucidated. However, apparently, under the influence of endocrine, vascular, metabolic and immunological changes, the reactivity of cortical-subcortical structures (probably nuclear formations of the brain) is disrupted, the excitation threshold of which is significantly reduced. Therefore, any irritation from the periphery, especially irritation of the trigger zones by jaw movement (swallowing, chewing, talking, washing, brushing teeth, touching, laughing, blowing wind, etc.), can cause a reaction from the hypothalamic-stem formations. This leads to the development of painful paroxysms.

Features of symptoms. With trigeminal neuralgia of predominantly central origin, the main clinical picture is a short-term attack (from several seconds to several minutes) of excruciating pain of a very different nature (such as “passage of current”, burning, as well as shooting, tearing, cutting, stabbing) in the innervation zone one or more branches of the trigeminal nerve. The attack stops suddenly, ending abruptly; there is no pain during the interictal period. The area of ​​pain distribution coincides with the zone of innervation of the nerve only conditionally. Usually it goes beyond the boundaries of the innervation of a section of a particular nerve branch. Often spreads vertically, to both cheeks and lower jaw. An attack of pain may be accompanied by reflex contractions of the facial and masticatory muscles in the form of a tonic spasm of the corresponding half of the face. During an attack, patients freeze in a suffering pose, afraid to move. Sometimes they take peculiar poses, fearing that an inadvertent movement will intensify or prolong the paroxysm, they hold their breath or, conversely, breathe heavily. Some patients squeeze the painful area or rub it with their fingers, trying to make movements (smacking) that help quickly stop the pain. Often, during a painful attack, hyperkinesis of the face occurs in the form of clonic twitching of its small muscles, sometimes of all facial muscles (pain tic). Attacks of neuralgia are usually provoked by irritation of trigger (trigger) or algogenic zones, which are a peculiar sign of an altered functional state of the sensitive nuclei of the trigeminal nerve. Trigger zones, found in approximately half of the cases and determined in the zone of innervation of the corresponding branch of the trigeminal nerve, are sometimes migratory in nature. Most often they are located around the mouth and in the gum area, but can be on the skin of the face and in the oral cavity: on the mucous membrane of the cheek, alveolar process, teeth, the mechanical or thermal irritation of which provokes an attack. What matters is the vertical load on the teeth, which occurs when the jaws are sharply clenched, walking on an uneven surface, or suddenly falling from the toes to the heels. The more algogenic zones, the more severe the disease. Their appearance indicates an exacerbation of the disease and, conversely, their disappearance is an indicator of the onset of remission. Sharp pressure on the trigger zone can interrupt an attack of neuralgia.

Painful paroxysms develop mainly in the morning or during the day, rarely at night. As a rule, pain occurs in the area of ​​the second or third branch, sometimes in the area of ​​both branches. Neuralgia of the first branch is extremely rare and one should be very careful when making a diagnosis. Similar symptoms occur with frontal sinusitis, local inflammatory processes, sinus thrombosis, etc. But more often it is the irradiation of pain from the second branch of the trigeminal nerve to the first.

In approximately% of cases, the development of paroxysmal pain is preceded by paresthesia in the form of tingling, “crawling”, as well as constant dull, aching pain in the teeth (one or more), less often in the jaws. Approximately 1/3 of patients undergo various dental procedures in connection with these complaints, including the removal of intact teeth. One of the signs of a relapse of the disease process is the appearance of precursors in the form of a feeling of “grown teeth,” heat, itching, hyperhidrosis, and red spots on the skin of the face.

Trigeminal neuralgia of predominantly central origin is more common in women than in men (ratio 3:2). The disease usually begins between the ages of 40 and 60 years, which suggests the influence of vascular and endocrine metabolic factors on the mechanisms of its development. The course of the disease is chronic, with remissions.

On palpation, pain is detected at the exit points of the trigeminal nerve: foramen supraorbitale, foramen infraorbitale, foramen mentale. In some cases, there are also distant pain points, for example, pain in the middle cervical vertebrae. Trigger zones and hyperalgesia are often detected in the area of ​​the corresponding branch of the trigeminal nerve. In the clinical structure of painful paroxysm, a significant place is occupied by autonomic disorders: hyperemia, swelling of the face, lacrimation, rhinorrhea, hypersalivation, injection of scleral vessels, etc. In rare cases, there may be the opposite phenomena: dryness of the oral mucosa, increased heart rate. During an attack, body temperature may rise by several tenths of a degree on the side of the painful paroxysm. Neurotic disorders are expressed: depressive syndrome, anxiety-phobic, hypochondriacal.

When the Gasserian node is damaged and ganglioneuritis develops, rashes are observed, often in the zone of innervation of the first branch. Trigeminal neuritis is characterized by a sensitivity disorder in the form of hypoesthesia, trophic disorders of the eye (keratitis), reduction or loss of the corneal (if the first branch is affected), mandibular reflexes (if the third branch is affected), weakness and atrophy of the masticatory muscles.

Bilateral trigeminal neuralgia of predominantly central origin. It occurs in women 2 times more often than in men. It occurs mainly between the ages of 40 and 50, and in men - at a younger age.

This is a chronic disease that lasts for decades. As a rule, pain appears on one side, and after some time (a significant time interval - from several months to several years) - on the other. The second and third branches of the trigeminal nerve are most often affected, on one or both sides. Combined damage to these branches is usually observed on one of the affected sides.

Age-related, allergic and vascular factors are important in the pathogenesis. Provoking factors are infections, hypothermia, poor-quality dental prosthetics, mental trauma, etc. Paroxysms of pain usually appear alternately on different sides of the face. Only in some patients is there a simultaneous development of paroxysm on both sides, but still more often with a predominance on any one of them. In 50% of cases, during the acute period of the disease, trigger zones are identified, more often in the nasolabial area, less often in the lateral parts of the skin of the face and in the oral cavity. They are often located symmetrically on both sides, sometimes they are migratory in nature. Most patients experience pain at the exit points on the face of the affected branches of the trigeminal nerve, hypoesthesia with areas of anesthesia, hyperesthesia with areas of hyperpathy (usually in patients in whose treatment destructive methods were previously used), severe autonomic disorders and asthenoneurotic reactions.

Emergency care during an exacerbation of trigeminal neuralgia of predominantly central origin. In case of significantly severe pain syndrome, the administration of analgesics such as tramadol (1-2 ml intravenously slowly or intramuscularly), trabar, tradol, tramagit, tramal, baralgin - 5 ml slowly intravenously, maxigan - 2 and 5 ml intramuscularly. For intractable pain syndrome, diclofenac (syn. dicloran, diclomax, dicloberl, bioran, dik, diclobrew, diclonac, naclofen, revina, olfen, epifenac, feloran) is administered - 75 mg (3 ml) intramuscularly.

The effect of analgesics is enhanced by antihistamines and tranquilizers (diphenhydramine, seduxen, pipolfen), as well as neuroleptics (plegomazine, aminazine), levomepromazine (tizercin). For persistent neuralgia, 2 ml of a 0.25% solution of droperidol is slowly administered intramuscularly or intravenously in combination with the synthetic analgesic fentanyl (2 ml of a 0.005% solution) or a mixture of the following composition: 2 ml of a 50% solution of analgin, 2 ml of a 0.5% solution of novocaine and 1 ml of 2% promedol solution (prepare ex tempore).

At the same time, the anticonvulsant drug carbamazepine (finlepsin, stazein, tegretol, amizepine, mazetol) is prescribed in individually selected doses. If the patient has not previously received this drug, it is prescribed orally, starting with 1 tablet (0.2 g) 1-2 times a day daily, gradually increasing the dose per tablet and bringing it up to 2 tablets (0.4 g) 3-4 times in a day. In% of cases, the clinical effect is achieved on the 2-3rd day of the disease. Patients who have previously received the drug can be immediately prescribed carbamazepine 2-3 tablets (0.4-0.6 g) times a day. It is better to prescribe treatment from a dose that gives a therapeutic effect. After the pain disappears, the dose is gradually reduced to maintenance (to 0.2 - 0.1 g per day).

Trigeminal neuralgia: etiology, pathogenesis, classification, clinical picture, diagnosis, differential diagnosis, treatment.

This is localized pain in the facial area. The disease is has been known for a long time. The mechanism and pathogenesis of this pain syndrome are not clear. Theories of the pathogenesis of trigeminal neuralgia:

1. Mechanical theory

Nerve trunks are compressed at their exit points, namely their oval and round foramina. This theory is justified by the fact that neuralgia is the first■ branches of the trigeminal nerve" is rare, because it exits through the wide superior orbital fissure. And the second and third branches exit from the oval and round foramina, according to researchers (Burdenko), when examining a large number of skulls, it was found that on the right side these holes are much narrower than on the left. And neuralgia occurs on the right much more often than on the left. This theory is supported by the fact that neuralgia is rare at a young age. It occurs after the age of 40, when the growth of bones and the trigeminal nerve root stops throwing over the pyramid of the temporal bone at a right angle, it is stretched due to the fact that the intervertebral discs are reduced and the brain is shifted towards the occipital foramen (Anavekron's theory, 1941).

2. Most authors believe that this disease is associated with inflammatory diseases in the dental system. These are diseases such as: chronic periodontitis* of denticles, calcification of bone canals in which nerve fibers pass to the teeth, retention of 3.5 or 8 teeth, etc.

Of great importance is chronic inflammation of the paranasal sinuses (sinusitis and sinusitis), diseases of the mandibular joint, and cervical osteochondrosis.

Great importance is now attached to the disturbance of vascular tone in hypertension, atherosclerosis, when the trophism of the trigeminal nerve is disrupted.

5. Disruption of connections between the trigeminal nerve and the sympathetic nervous system is of great importance.

6. There are isolated descriptions of the occurrence of neuralgia in two or three generations. But these observations do not give reason to talk about a hereditary factor in the development of trigeminal neuralgia.

Interestingly, during times of severe stress, neuralgia goes away completely. This situation is inexplicable; apparently the stressful situation prevails over the pain syndrome.

Trigeminal neuralgia clinic.

This is a chronic disease characterized by paroxysmal pain.

Pain occurs in the area innervated by any branch of the trigeminal nerve. Right-sided neuralgia is twice as common as left-sided neuralgia. Women get sick more often than men. The disease usually begins after 40 years of age.

A characteristic symptom of this disease is paroxysmal pain that develops suddenly against the background of complete health. Brley of a piercing, cutting nature. Patients describe the pain as follows: as if a nail is being screwed into the face. The pain is intense, unbearable, localized in a certain part of the face. Patients do not touch their faces because this intensifies the attack. The attack lasts up to 1 minute, no more. Between attacks the patient is absolutely healthy, but he does not touch the diseased half of the face, because touching may cause a new attack of pain.

With neuralgia of the first branch, the pain is localized in the area of ​​the eye, superciliary arch, forehead and the anterior surface of the temporal region.

With neuralgia of the second branch, pain is localized in the area of ​​the upper lip, wing of the nose, nasolabial fold, lower eyelid and teeth of the upper jaw, as well as the palate. The patient will ask to remove the diseased tooth, although it is intact.

With neuralgia of the third branch, pain is localized in the lower lip, chin, lower jaw teeth and tongue.

The second symptom of neuralgia is that attacks appear only during the day. During an attack, the patient experiences increased secretion of saliva and nasal secretions, sweat appears on the affected side, and the skin turns red.

If the patient complains of pain and at the same time touches the sore spot or allows the doctor to touch it, then this is not trigeminal neuralgia.

Patients have a trigger zone, which causes a painful attack when touched. Such zones exist in the area of ​​exit of the infraorbital nerve, mental nerve, and supraorbital nerve.

If patients suffer from neuralgia for a long time, then due to nervousness, herpes zoster appears on the skin of the face along the nerve. In addition, graying of hair occurs on the corresponding side. Patients stop eating because when they open their mouth they have a seizure. Patients lose weight quickly. In addition, they do not wash their face, suffer from eczema, stomatitis, tartar deposits, and pustular lesions of the facial skin. Sick men don't shave.

Despite the fact that the neuralgia clinic is very bright, there is still no classification of neuralgia. Our doctors divide neuralgia into:

1. Idiopathic, the cause of which is not clear.

2. Symptomatic (secondary), when there is a cause, for example, chronic sinusitis, after the elimination of which neuralgia remains.

Differential diagnosis of trigeminal neuralgia:

1. Trigeminal neuritis, i.e. nerve inflammation.

The pain is constant, there are almost no intervals between them, and they intensify at night. There are no convulsive phenomena in the facial area with neuritis. The patient does not scream during attacks; he describes the pain as deep, diffuse and dull.

2. Neuralgia of the glossopharyngeal nerve.

This disease was first described in 1910 by Weissburg. The reason is unknown. Characteristic symptoms: severe paroxysmal pain in the root of the tongue, in the velum, in the tonsil, in the ear area. That is, the pain does not spread along the branches of the trigeminal cervix. The pain is unilateral, occurs and intensifies during swallowing, laughing, talking and coughing. During an attack, dry throat appears and

cough.

Trigger area: tonsil and root of tongue.

3. Neuralgia of the pterygopalatine ganglion.

Characterized by severe pain in the upper jaw, palate, root of the nose and eyes. Sometimes the pain syndrome spreads to the neck and upper limb. Patients develop persistent runny nose, lacrimation and photophobia.

4. Glossalgia.

It is characterized by unpleasant sensations in the form of “crawling goose bumps” in half of the tongue. As a rule, there are no painful attacks, the pain is constant. In this case, it is necessary to exclude traumatic moments: sharp edges of teeth, uncorrected dentures.

Glossalgia often accompanies gastritis, pancreatitis, and cholecystitis. Prosthetics with different metals lead to the emergence of electrical potentials that cause a burning sensation in the tongue.

5. Osteochondrosis of the cervical spine.

The pain is constant, intensifies when turning the head. It is necessary to take an x-ray of the cervical spine and exclude osteochondrosis. - .

6. Arthritis of the temporomandibular joint. There are no paroxysmal pains.

7. Pulpitis.

Characterized by pain in the tooth, which intensifies at night. A carious tooth is visible in the oral cavity. With pulpitis, the pain is prolonged, and with neuralgia it lasts up to 1 minute.

8. Sinusitis.

Often, after eliminating pulpitis, neuralgia remains, because nerve toxicity occurred

9. Malignant tumors of the upper or lower jaw.

The patient will complain of pain in the teeth, although they may be intact. The pain is constant, not paroxysmal.

10. Inflammation of the middle ear.

The pain is constant. There will definitely be an elevated body temperature, which is not the case with neuralgia.

Treatment of trigeminal neuralgia.

Because The cause of this disease is not clear, the treatment is complex, mainly symptomatic. After treatment, the pain may return.

1. Blockade with a 1% novocaine solution at the exit points of the branches of the trigeminal nerve (supraorbital, infraorbital, mental nerves). A 1% solution is used, rather than 2%, which is more often used in the clinic, because Vishnevsky proved that small concentrations of novocaine have a positive effect on tissue metabolism "and have a therapeutic effect due to nerve blockade. And a 2% solution with prolonged use causes nerve degeneration, i.e. neuralgia turns into trigeminal neuritis. 1 g can be administered simultaneously dry matter of novocaine.

The blockade is performed 2 times a week, 5-10 ml of a 1% solution. After administration, tissue swelling occurs, so the blockade is not performed often so that swelling due to mechanical compression of the nerve does not aggravate the process. It is necessary to conduct 10-12 sessions, which last on average for 2 months.

2. Acupuncture. This method is based on the connection of internal organs with facial skin. This technique is scientifically substantiated and should be carried out by a specialist who has completed special courses.

3. Tissue therapy. Academician Filatov proposed this method in 1933 with the aim of stimulating the body's immune defense. Vegetable or animal protein is taken, sterilized and injected subcutaneously, usually into. abdominal or chest wall, but not in the area of ​​the face. Long-term absorption of this protein stimulates the immune system. You can prescribe aloe and vitreous extract.

4. Oxygen therapy. This method is used in the facial area (20-50 ml of oxygen is injected subcutaneously) or a pressure chamber is used (3 atm for an hour).

5. Vitamin B]2, - administered intramuscularly: Use no more than 8-10

injections.

6. Physiotherapy uses diadynamic currents; they provide an analgesic effect, increase the threshold of pain sensitivity, and normalize vegetative processes. 7. Anticonvulsants are used as medications: finilin (dielintin) and finlepsin - 1 tablet 3 times a day. There are other treatment methods that our department views negatively:

1. Use of boiling water. This method was proposed by the American doctor Yeager. He introduced boiling water to the site where the branches of the trigeminal nerve exit the skull (oval or round foramen). Here, 10 years ago, this method was widely used by Livshits in Saratov. The essence of the method is that soft tissue is burned at the base of the skull. After scarring of the burn, the tissue compresses the nerve and no other conservative methods help.

2. Alcoholization with 80% alcohol. When alcohol is injected into a nerve, intravital degeneration of the nerve fiber occurs. The pain returns after 8-10 months, and other treatment is no longer effective.

3. The method was proposed by Professor Kurbangaliev at our institute. This is a surgical treatment method: transection of the trigeminal nerve root or removal of the Gasserian ganglion. The operation is very difficult and has many complications: patients lose memory and have poor orientation in the external environment. Only three such operations were performed; now they are not recommended due to severe complications; headaches that occur as a result of loss of cerebrospinal fluid and air entry into the subarachnoid space, imbalance with a tendency to fall to the affected side, atoxicity in the arm and leg on the side of the operation, serous meningitis, Borner's syndrome, nystagmus.

The hardest thing is death on the operating table.

The trigeminal nerve belongs to the 5th pair of cranial nerves and has branches - the ophthalmic one, located in the upper jaw and located in the lower jaw. When the inflammatory process develops in the area of ​​this nerve, they speak of neuralgia.

What it is?
Trigeminal neuralgia is a chronic disease in which the branches of the nerve are affected, as a result of which the patient suffers constant paroxysmal pain in the area of ​​their innervation. With this pathology, pain occurs more often in one half of the face.

Common causes of facial trigeminal neuralgia are:

1. Hypothermia of the body;
2. Foci of chronic infection in the body (carious teeth, sinusitis, tonsillitis, etc.);
3. Tumor-like formations in the brain;
4. Aneurysm of cerebral blood vessels;
5. Compression of the nerve by the bones of the skull;
6. Osteochondrosis in the cervical region;
7. Received head injuries;
8. Herpetic infection;
9. Polio;
10. Previous surgical interventions on the oral cavity.

People at risk are:

• Over 45 years old;
• Subject to constant stress;
• Those suffering from vitamin deficiencies;
• Allergy sufferers;
• Persons with ;
• Suffering from disorders of the endocrine system (hypo and hyperthyroidism).

The main clinical symptom of trigeminal neuralgia is pain, usually localized on one half of the face. The attack occurs suddenly, with the slightest irritation of the affected nerve. The patient complains of shooting pain, which is often equated to electric shocks.

The pain does not last long, usually no more than a few minutes. After this, a period of remission begins, which can last up to several weeks or months, but as the disease progresses, pain occurs more often, and the intervals between them become shorter.

With neuralgia of the 1st branch of the trigeminal nerve, pain is localized in the area of ​​the wing of the nose, eye, eyebrow, temple, crown.

The next attack of pain is provoked by simple actions of the patient:

• Smile, laugh, yawn;
• Hygiene procedures and simple touching the face, etc.;
• Eating and chewing movements;
• Staying in cold or drafty conditions.

In addition to pain, before effective treatment begins, symptoms of trigeminal neuralgia include the following conditions:

1. Lacrimation on the affected side;
2. There may be copious clear nasal discharge;
3. Redness of the lower eyelids and mucous membranes of the eyes;
4. Twitching of the facial muscles - the affected half contracts convulsively;
5. Mental disorders of the patient - so any actions (laughter, eating, yawning, etc.) can provoke another attack of pain, the patient becomes irritable, withdrawn, refuses to eat, and is afraid to fall asleep. In addition, in severe cases, thoughts of suicide are possible;
6. Impaired sensitivity of half the face - the patient complains of numbness of the face in the affected area, a feeling of goosebumps crawling under the skin;
7. Atrophy of the muscles of the affected half of the face - develops as a result of impaired blood supply and lymph drainage. Under the influence of such changes, eyelashes, eyebrows, and teeth fall out on the affected half of the face, wrinkles appear, the corner of the lips rises, the eyelid droops, and chewing ability deteriorates.

Diagnosis of neuralgia

Diagnosis of trigeminal neuralgia begins with a visit to a neurologist. The doctor examines the patient during remission and after influencing pain points, the influence of which can provoke an attack of pain, collects an anamnesis of life and illness, and prescribes additional studies:

• Electroneurography;
• Computed tomography, MRI;
• Electroencephalography;
• Blood biochemistry;
• Spinal cord puncture if necessary - if there is a suspicion of;
• Consultation with an otolaryngologist, dentist, neurosurgeon.

Treatment of the disease is carried out comprehensively; the main steps in the treatment of trigeminal neuralgia are as follows:

• Preventing factors that can trigger the development of neuralgia;
• Normalization of the central nervous system – prevention of stress, reduction of hyperexcitability;
• Physiotherapeutic procedures – electrophoresis, acupuncture, massage.

To relieve an attack of trigeminal neuralgia and prevent pain in the future, the patient is prescribed the drug Finlepsin. This medicine belongs to the group of anticonvulsants and helps reduce the excitability of nerve fibers and inhibit the production of neurotransmitters.

This drug can be taken strictly according to the doctor’s indications and in an individually designated dosage, since the tablets have a number of serious contraindications.

In addition to Finlepsin, the patient is prescribed:

• B vitamins – have a beneficial effect on the functioning of the central nervous system;
• Sedatives – Valerian;
• Glycine or Glitsed - amino acids involved in the transmission of nerve impulses;
• Antihistamines;
• Muscle relaxants;
• Antidepressants.

During stable remission, physiotherapeutic and sanatorium treatment is indicated.

Surgical treatment of trigeminal neuralgia

If conservative treatment methods are not effective, the patient is prescribed surgery. The main indications are brain tumors, the presence of narrowed areas in the nerve exit channel from the skull, pinched nerve branches, etc.

In modern surgery, surgery to eliminate trigeminal neuralgia is performed with a laser. This intervention is minimally invasive and is well tolerated by the patient.

Forecast

If you seek medical help on time and receive proper treatment, the prognosis for the disease is generally favorable. Following simple preventive recommendations allows you to achieve stable remission or completely get rid of the problem.