Trigeminal Neuralgia

Trigeminal neuralgia, which is known by names such as "The disease that drives you crazy", "The disease that drives you crazy", "The worst pain in the world", causes a picture that is extremely disturbing to the patient with the pain it creates.

The cause of trigeminal neuralgia

Trigeminal neuralgia is one of the nerves located at the base of the skull, called the trigeminal nerve cranial pairs. After the nerve emerges from the base of the skull, it divides into three branches from the upper part of the ear and spreads to the face. The condition in which these branches cause pain as a result of the contact of the arteries or veins is called Trigeminal Neuralgia. In addition to vascular problems, trigeminal neuralgia may also develop in diseases such as nerve compression by tumors and multiple sclerosis. Pain is felt in the spreading areas of the affected nerve branches.

There are 2 trigeminal nerves on the right and left, and after leaving the area called the brainstem, it is divided into 3 branches:

The first branch is the person's upper eyelid and provides the feeling of the forehead

The second branch provides the feeling of the lower eyelid, upper jaw, nose and eyelid, and the cheek part

The third branch It provides the feeling of the lower jaw and its inner part and the function of some muscles related to chewing.

As usually one of these branches, sometimes more, is affected, severe pain occurs mostly in the lower jaw area, then in the upper cheek and eye area. shows. Involvement of two separate branches together may also occur, but involvement of three branches is very rare.

Although it can be seen at any age, it usually occurs over the age of 50. It is more common in women than men. It is also thought to have a genetic (familial) origin. It is stated that trigeminal neuralgia develops in some families as a result of irritation caused by abnormal vascular structures. However, the cause usually cannot be determined. Multiple sclerosis, cancer and high blood pressure are considered risk factors.

Symptoms of trigeminal neuralgia

The disease usually begins spontaneously, without a cause. Sometimes, there is an event in the patient's history such as a trauma or dental treatment. Branch pain affecting the lower or upper jaw is often confused with tooth abscess or toothache in the first stage, and patients may undergo some dental treatments until they are diagnosed. Ha When the patient's pain does not subside, a diagnosis of Trigeminal Neuralgia is made. Although the cause and effect relationship cannot be clearly established, it is thought that the nerve is already under irritation and traumatic events caused the pain to occur. According to another idea, the disease occurs due to damage to the nerve during treatments performed in the tooth or jaw area.

Trigeminal neuralgia shows 2 types of course. In the so-called classic type, the patient has painful and painless periods in the affected area. Pain usually occurs spontaneously or when the affected area is stimulated. In the non-classical type, the pain never goes away, there is no pain-free period, and the affected area spreads over a larger area. Due to the widespread pain, the diagnosis may be made a little later. In the course of classical type Trigeminal neuralgia, after a painful attack, sometimes the patient does not experience a painful attack for months or even years. Painful periods may increase and pain-free periods may decrease over time.

Trigeminal neuralgia may be triggered in the following situations:

• Lightly touching the skin of that side

• Washing

• Shaving

• Brushing teeth

• Breathing by blowing the nose

• Drinking cold or hot drinks

• Exposure to a light breeze

• Laughing

• Talking

The pain is very severe and throbbing It is felt in the lower jaw, upper jaw, cheek or eye area. It is usually unilateral, but it can also be seen bilaterally. Pain attacks can last from a few seconds to a few minutes. Some patients may have hundreds of attacks a day and can have a very negative impact on the patient's life. During attacks, the patient keeps grimacing, which is why Trigeminal Neuralgia is also called "Painful Tic". Numbness and tingling may be felt in the affected area before the pain begins. The pain continues during sleep.

Findings and diagnosis in Trigeminal Neuralgia

There are no diagnostic findings detected during the examination. However, it is necessary to perform a careful neurological examination, considering the neuropathic pattern of the pain and the underlying neurological diseases, which is already the case. The absence of any neurological findings detects the diagnosis.

Jaw diseases, jaw involvement of inflammatory rheumatic diseases (such as rheumatoid arthritis), occipital headache (headache radiating from the neck up and sometimes to the face), upper segment problems of the neck. should also be kept in mind in the differential diagnosis.

 Again, evaluation with brain MRI can be performed to exclude neurological conditions, and MRI angiography can be performed due to underlying vascular pathology.

Treatment in Trigeminal Neuralgia

The classical treatment of Trigeminal Neuralgia is to use medication. The most preferred drugs are antiepileptic drugs such as carbamazepine, gabapentin, baclofen, and benzodiazepine group tranquilizers. There are difficulties in adjusting the drugs rather than their side effects. Some patients require higher doses to reduce pain and have a higher chance of side effects. The effectiveness of antiepileptic drugs decreases after a certain period of time. When this high dose is increased, toxic effects occur. These toxic effects may affect the bone marrow, kidney and liver, so these patients should have their blood values ​​checked at regular intervals.

As classical information, surgery is recommended in Trigeminal Neuralgia where medications do not help. Surgeries can be performed using open or closed methods.

 

Acupuncture: Acupuncture, which acts by regulating the energy systems in the body, is a method that can be used both in pain control, sleep control and psychological state regulation. While trigeminal neuralgia is regulated by the use of specific and recommended points, other problems can also be treated from a holistic perspective.

Neural therapy:  

Ozone therapy: Ozone therapy, which acts by activating the antioxidant mechanism in patients with trigeminal neuralgia, reduces both the blood pressure called major ozone. It provides a treatment opportunity both by ozonating and applying it locally to the exit and distribution areas of the nerve.

Patients with trigeminal neuralgia should stay away from factors that may trigger the attack as much as possible. In windy, cold weather, the face should be protected, very hard, very cold or very hot foods should be avoided, and dental health should be taken into consideration. li.

 

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