Trigeminal neuralgia - consequences. Treatment of trigeminal neuralgia in various ways Inflammation of the trigeminal nerve first aid

The defeat of the branches of the trigeminal nerve causes severe physical and moral discomfort in a person. In some cases, the patient cannot lead a normal life due to the appearance of cramps in the muscles of the face.

A trigeminal nerve lesion causes severe pain that radiates to one side of the face. To reduce sensitivity and thereby reduce the manifestation pain syndrome, you need to know how to treat trigeminal neuralgia.

Medical treatment

Pharmaceutical preparations form the basis of therapy for. They can be supplemented by a doctor's prescription. folk recipes. One of the most effective and popular means is Carbamazepine. It ensures the development of inhibitory processes in nerve fibers, due to which their painful excitation disappears.

You need to take the pills for about 8 weeks. The action of Carbamazepine is noticeable already on the 1-2 day of treatment, after taking the remedy, the pain of the facial nerve disappears for several hours. Since these tablets are very toxic, specialist assistance is needed in a thorough analysis and individual selection of a treatment regimen.

Carbamazepine is contraindicated during pregnancy and breastfeeding. It has a toxic effect on the developing embryo. In addition, pills are prohibited when a person has glaucoma, blood diseases, or heart block.

In addition to carbamazepine, for the relief of pain in the face are used:

intravenous drugs (sodium oxybutyrate) - administered by ambulance doctors;
anticonvulsants (Pantogam, Phenibut, Baclofen) - relieve pain for 2-3 hours;
neuroleptics (pimozide) - additional treatment of the facial nerve;
Glycine - prescribed for a long course to eliminate nervous excitement;
antihistamines - used to enhance the therapeutic effect;
anti-inflammatory drugs - nonsteroidal drugs that eliminate facial pain;
vasotonics - prescribed for concomitant pathologies of cerebral vessels;
vitamins - during exacerbations, vitamins of groups B and C are used in the form of injections.

Medical treatment in combination with folk remedies only relieves pain in the region of the facial nerve, without helping to eliminate the root cause of the pathology. Trigeminal neuralgia is a complex disease that cannot be treated with oral medications. Pain-relieving tablets help by alleviating the patient's condition, reducing the excitability and conduction of nerve fibers.

Physiotherapy procedures

Physiotherapeutic treatment complements the medication, enhancing its effectiveness. The attending physician selects the necessary procedures depending on the degree of development of the disease, the strength of the pain syndrome and the presence of concomitant chronic pathologies in a particular person.

An effective method, the effectiveness of which is ensured by the impact of thin needles on certain points of the face, the collar zone and areas of the face located directly near the facial nerve. It is necessary to carry out such procedures only in a trusted clinic with a real professional, since the impact on acupuncture points has a strong effect on the functioning of all body systems.

electrophoresis

The impact of current on certain areas ensures the establishment of the work of the necessary parts of the body. Treatment of trigeminal neuralgia with herbal electrophoresis provides a lasting effect (in the case when the auxiliary agents and the treatment regimen are chosen correctly). Therapy with conservative means helps only in the first stages of the development of the disease.

Ultrasound

The procedure is the impact of ultrasound on the exit area of the branches of the trigeminal nerve with a small head (about 1 cm2). Treatment is carried out in a course of 10 procedures, affecting each zone for no more than 1-3 minutes.

Laser exposure

It is considered one of the most effective procedures. The impact of laser radiation on the skin contributes to the penetration of radiation directly to the inflamed area of the facial nerve. Thanks to this, the pain subsides, the general condition of the patient improves, and pain attacks bother him much less often.

Magnetotherapy

This method of physiotherapy improves the metabolic processes inside the cells of the body. Exposure to magnetic means ensures the removal of toxic substances, a decrease in swelling, a decrease in inflammation, the normalization of the work and condition of nerve fibers and small vessels.

Surgical intervention

If physiotherapy and pills do not work help you need, the patient is offered to perform an operation to eliminate the cause of the disease. Only the attending physician can choose by what means to carry out surgical intervention, based on the data presented on the course of neuralgia.

rhizotomy

It is an operation to rupture the trigeminal nerve. An incision is made in the skin behind the ear and a branch of the trigeminal nerve is dissected, which provides sensitivity to certain areas of the face. Due to such a radical method, the effect is achieved.

RF ablation

During surgery, the nerve node is exposed to high temperature, as a result, the nerve fiber is destructured, and the pain gradually subsides. Surgery is performed under local anesthesia, the patient does not need long-term hospitalization, therefore, if desired, he can leave the medical facility in a few hours and continue treatment with medications or folk remedies that the doctor will advise.

The lasting effect of the operation appears only after a month. That is why after the operation the patient will feel pain for a long time.

Microvascular decompression

It consists in removing or moving the choroid plexuses in contact with the trigeminal nerve. The operation is performed under general anesthesia, the main assistance is provided by neurosurgeons. The efficiency of this method is only 80%.

Glycerin injections

They are effective means against pain in case of inflammation of the facial nerve. Using a thin needle, the drug is injected into the branching of the trigeminal nerve. Such injections provide a long-term analgesic effect, but relapses are common in the later stages.

Folk ways to eliminate pain

Folk remedies can slightly alleviate your condition until the doctor prescribes effective treatment.

Geranium

Fresh scented geranium leaves are used as compresses. The raw material is applied to a thin linen fabric and bandaged to a sore spot. The analgesic properties of fragrant geranium are determined by the presence of essential oils and other trace elements in the composition of the plant.

Help is due to the rich composition of the plant, which provides an anti-inflammatory and analgesic effect in the face.

Black radish

Freshly squeezed black radish juice must be rubbed several times a day into the affected area of the facial nerve. This method has a good and lasting effect, providing a decrease in the sensitivity of nerve endings and a decrease in pain.

With an exacerbation of the pain syndrome, it is necessary to boil an egg hard-boiled, cut it in half and attach it to the area that hurts the most. By the time the egg cools, the pain will subside or disappear altogether.

marshmallow root

Used for compresses for inflammation of the facial nerve. In the evening, it is necessary to prepare an infusion from the marshmallow root, pouring 1 teaspoon of dry raw materials with a glass of boiling water and insisting overnight.

In the morning, a decoction of chamomile is collected and kept in the mouth, and at this time gauze is applied outside, soaked in an infusion of marshmallow root. To enhance the effect, it is necessary to cover the gauze with compression paper and a woolen cloth. Help from such a remedy consists in a double effect on the affected nerve with folk remedies.

It is better to do compresses several times a day. In this case, the pain will recede faster, and relapses will occur less frequently.

The abuse of folk methods of treatment negatively affects health and causes complications. All analgesic properties of plants are due to their special composition.

Among the modern methods of treatment of neuralgia, radiosurgical intervention can be distinguished. During the operation, a cyber knife is used, so doctors manage to control the dosage of radiation, the place and strength of the photon flux on the inflamed area of the nerve ending.

The procedure is carried out quickly, local anesthesia is used to anesthetize the patient, so the rehabilitation period proceeds smoothly. As a prevention of relapse, you can use folk recipes, but only after consulting a doctor.

The main and most painful sign of inflammation of the trigeminal nerve is severe, almost unbearable pain. Pain usually occurs only on one side of the face, inflammation of both sides is rare.

The pain is not constant, but paroxysmal, resembling an electric shock. The attack lasts from ten seconds to two minutes, although it seems to the patient that an eternity has passed. After that, relief comes, the pain disappears for a while. Depending on the severity of the disease, attacks can occur every hour or once a day.

The trigeminal facial nerve, the treatment of which can last more than one month, has three branches:

With inflammation of the first branch, pain occurs in the eye area and spreads to the forehead.
If the second branch is inflamed, the pain occurs in the upper jaw and passes to the temple. Often people confuse it with a toothache and turn to a dentist rather than a neurologist.
With inflammation of the third branch, the lower jaw and chin hurt, the pain flows into the ear area.

During an attack, the patient does not scream and does not take the fetal position, rather, on the contrary, he tries to sit still and be silent. At the same time, he may experience increased lacrimation and salivation.

By the nature of the pain, a typical and atypical variety can be distinguished:

The typical pain of nerve inflammation lasts no longer than a minute and does not recur often, giving the patient the opportunity to eat or talk.
Atypical pain is very strong, frequent, occurs spontaneously, depriving a person of the opportunity to communicate and eat normally.

Usually, pain does not appear by itself, but as a result of an irritating factor called a trigger. Anything can serve as such a provocateur - talking, chewing, yawning, touching a certain area of \u200b\u200bthe face, and even brushing your teeth. In a state of complete rest, in a dream, seizures occur extremely rarely.

In the absence of proper treatment, attacks become more frequent, and the pain becomes more intense. With trigeminal neuritis, the localization of pain does not change, even if the disease has lasted for several weeks. The pain occurs in the same place and spreads in the same direction (for example, from the upper jaw to the temple area).

In addition to pain, sometimes involuntary twitching of the facial muscles is observed, more often during or immediately after a pain attack.

Due to the fact that patients try to chew only on the healthy side of the jaw, so as not to provoke an attack, muscle seals form on this side of the face. In addition, the sensitivity of the affected area of the face is significantly reduced.

Causes of inflammation of the trigeminal nerve

Everyone who has ever encountered trigeminal neuritis knows that this is a very painful and long-term ailment that requires careful and immediate treatment. Most often, this disease affects women over 40 years of age.

There can be several reasons for trigeminal neuritis:

Hypothermia. The most common cause of inflammation of the trigeminal facial nerve. The most dangerous period is the cold season. The impetus for the development of inflammation can be a draft in the minibus, the air conditioner turned on at full capacity, or just a strong wind on the street.
Infection. A banal draft cannot cause nerve inflammation if the body is not already weakened and infected. It can be a viral infection, inflammation of the ear, brain. The most common cause is the herpes virus present in the body. This is proved by the fact that very often, after the onset of the inflammatory process, a characteristic herpetic rash appears on the face.
Complications after chronic infection (sinusitis, otitis, caries). Sometimes trigeminal neuritis is confused with sinusitis and the disease is not treated at all (with self-medication). And at times, a really existing sinusitis can cause inflammation of the nerve. Inflammatory processes in the maxillary sinuses can go to a nearby nerve.
Anesthesia in the dental office. An unsuccessful injection into the gum can also provoke inflammation of one of the branches of the trigeminal facial nerve.
A brain tumor. Benign and malignant tumors in the brain often affect the nerves inside the skull. But in this case, inflammation of the trigeminal nerve is not the most dangerous symptom.
Multiple sclerosis. This is an extremely dangerous and almost incurable disease that affects the brain and spinal cord. The human immune system malfunctions and destroys the myelin sheath of nerve fibers, causing scarring of nerve tissue. In addition to impaired coordination of movements and deterioration of vision, one of the common symptoms is neuritis of the trigeminal facial nerve.
Traumatic brain injury. As a result of injuries, car accidents, the trigeminal nerve can be pinched by nearby arteries, which causes severe pain. In these cases, surgery is often necessary.
Incorrect arrangement of blood vessels. Congenital pathologies of the location of the vessels can provoke compression of one of the branches of the trigeminal nerve. The operation will also help to solve this problem.

Treatment of the trigeminal facial nerve

Treatment can be conservative or surgical. The expediency of this or that method of treatment is determined by the doctor. Observation of patients with the most severe forms of trigeminal neuritis takes place in a hospital.

Anticonvulsants. These drugs are designed to relieve pain by reducing the activity of nerve cells. The most popular is Carbamazepine. The effect occurs approximately on the second or third day of taking the drug and lasts up to 4 hours. The dosage is determined by the doctor. It may not change for a month, but then the dose should be reduced. You can take the drug for quite a long time, until the patient notes the absence of seizures for six months. However, this medicine has side effects (the liver, kidneys, mental state of the patient may suffer), so taking it without medical supervision is contraindicated.
Drugs that relax muscles. These drugs also help relieve pain and are often given at the same time as anticonvulsants.
Physical treatment. Physiotherapy relieves the patient's condition, relieves pain and tension. These include various warm-ups, phonophoresis, galvanization with novocaine.
Vitamins of group B. Vitamins are necessary during the treatment period. They help strengthen the body, cope with infection and speed up the recovery process. During an exacerbation of the disease, vitamins are injected intramuscularly.

More information about the trigeminal nerve can be found in the video.

In 30% of cases, drug treatment does not give the desired effect. Then the only way out is surgery. There are also several options for surgical intervention. The most effective type of operation will be selected by the doctor.

The last word in medicine is radiosurgery, when a certain dose of radiation enters the trigeminal ganglion and destroys it. This method is the safest, as it does not need anesthesia, does not leave scars and does without bleeding.

If the cause of the pain is nerve compression, a trigeminal nerve decompression technique may be used. The vessel that puts pressure on the nerve is displaced or removed. This is a fairly effective procedure, especially in cases of congenital malposition of blood vessels. However, it can give some complications, such as relapse, hearing loss, loss of sensation in certain areas of the face, stroke.

Effective is also the introduction of glycerol in the area of the trigeminal nerve. Glycerin quickly relieves pain, after a few hours. But a relapse is also not ruled out.

Treatment with folk remedies

Treatment of inflammation of the trigeminal facial nerve exclusively by means of traditional medicine will not give an effect. After several attempts to relieve pain with herbs and compresses, people usually go to the doctor anyway.

But you can consider various folk remedies as additional help during drug treatment. Of course, you should consult your doctor before using any of them. Self-medication can not only not improve, but also aggravate the situation, increase pain and accelerate the inflammatory process.

Of course, such funds do not work instantly. Any effect can be expected only with regular and proper use. Consider the most common traditional medicine designed to cure trigeminal neuritis.

Various heatings with buckwheat or salt give a short-term effect, but with the permission of a doctor, you can use this remedy. Buckwheat should be sewn into a dense fabric so that it does not spill out, heated in a dry frying pan and applied to the affected area for several minutes.

It is believed that a decoction of pharmaceutical chamomile will bring benefits if you keep it in your mouth for a long time. This will not help relieve pain, but if the cause of inflammation is an infection, chamomile will have a disinfecting effect.

A compress from marshmallow infusion can be useful for neuritis of the facial muscles. The finished solution on gauze is applied to the sore spot, carefully insulated from above with a handkerchief or scarf. After 30 minutes, the compress is removed, but the head is still insulated with a handkerchief. So you can go to sleep. This procedure must be done several times a week.

Sometimes it is recommended to rub fir oil into a sore spot. It also has a warming effect. But fir oil irritates the skin and can cause burns. The skin at the site of application will turn red and swell. This is a sure sign of a burn. Traditional medicine recipes often write that this is a normal reaction, but it is highly undesirable to perform such manipulations without consulting a doctor.

The use of folk remedies as an additional treatment measure allows you to speed up the process and achieve rapid pain relief. But with all methods, it is important to observe the measure, and it is better to consult a doctor in advance.

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Comments (4)

Tatyana

06/05/2015 at 23:33 | #

As winter comes, so I have inflammation. I follow all the doctor's recommendations: injections, pills, physiotherapy, I constantly wrap my face with scarves. Wild pain, who faced, he will understand. Do folk remedies help? Has anyone tried it?

09.10.2015 at 17:29 | #

Find on the Internet a method of treating brewed garlic, the vapors of which must be inhaled through the nose through a small home watering can. Tested on myself at 4 o'clock in the morning after a sleepless night 4 years ago. Before that, once when inflammation first occurred and I did not understand what kind of pain it was , used analgin tablets, drank 8 pieces in an hour, the result was zero. The neuropathologist wrote out something expensive, sold strictly according to the prescription in the pharmacy. that in the morning I had to go to a party with former classmates. I didn’t feel bad, but I went without pain, otherwise I would have had to abandon the trip, you yourself understand why.

waldi

10/12/2017 at 05:58 | #

In case of acute pains, I save myself by acupressure of the facial nerve, with my thumb, I strongly press on the nerve in the region of the masticatory muscles on the cheek, and with my index finger, in the region of the temple ...., I look for the most painful place and press with force ......, so I localize the pain from the lumbago pain of the facial trigeminal nerve.

A bit of humor: To treat inflammation of the trigeminal nerve, many doctors advise VIDEOTHERAPY - look at a woman's bare chest for a long time .... and then the pain in the face turns into passion……but how much to look and where to find a lady, the doctors are powerless here……Ha-Ha-Ha…….

Masha*

10/27/2017 at 19:09 | #

You are Humorous men - it pleases! I wish you not to get sick.😊

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The medical information published on this page is strictly not recommended for self-medication. If you feel negative changes in your well-being, contact an ENT specialist without delay. All articles published on our resource are informational and educational in nature. In the case of using this material or its fragment on your site, an active link to the source is required.

Treatment of inflammation of the trigeminal facial nerve

Neuritis is an inflammation of the nerve that manifests itself in the form of neurological symptoms. Such a pathological process is usually accompanied by acute, aching and shooting pain, and it can last from 2-3 weeks to a year. Such ailments include inflammation of the trigeminal facial nerve (trigeminal neuralgia).

According to statistics, such a disease most often occurs on the right side and mainly the female sex suffers from it after years. You can eliminate the inflammation of the trigeminal nerve on the face with the help of a course of therapy aimed at eliminating the pain attack and the cause of the disease.

Symptoms

The trigeminal nerve divides into three major branches. One of them passes over the eye, and the other two under the lower and above the upper jaw. Such branches cover the entire face of a person and respond to the innervation (connection with the central nervous system) of muscle tissue, skin and mucous membranes in this area. The main symptom that occurs with inflammation of the trigeminal nerve on the face is a sharp pain. It can be described as follows:

The inflamed nerve usually manifests itself in the form of severe pain resembling a burning sensation;
Signs of pain are predominantly localized in one place, but can be given throughout the face;
Attacks are usually extremely intense, but last mostly no longer than 3 minutes;
During a seizure, the patient has a twitching of muscle tissue;
With inflammation of the nerve on the face, hyperemia (blood congestion) sometimes occurs, as well as intense salivation and lacrimation;
If the inflammatory process in the tertiary nerve is strong enough, then the attacks may not actually stop for hours, and the pause between them will be no more than 2 minutes;
With severe pain, a person does not control facial expressions and freezes during an attack with a strange grimace.

The symptoms of inflammation of the trigeminal facial also include pain radiating into the gums. This symptom is especially manifested if the 2nd and 3rd nerve branches are damaged.

The patient often visits the dentist at the same time to find out how to treat the tooth, although it has nothing to do with it and it is necessary to eliminate the inflammation of the jaw nerve. An attack is usually provoked by any external stimulus and even laughter.

If left untreated, the triple nerve will not stop hurting. Attacks will occur more often and last longer. In such a situation, unpleasant sensations appear with any external stimuli and the slightest work of the muscles. Over time, half of the face will begin to go numb where the inflammation of the trigeminal nerve is localized and there will be a feeling of crawling on the skin, as well as tingling. In addition to the symptoms of paresthesia, signs of deterioration in the general condition can also be distinguished:

Symptoms of inflammation of the trigeminal facial nerve only get worse as the problem develops, and the patient gets the feeling that the pain diverges to other parts of the body, such as the hand. Physiologically, this is impossible, because other nerve branches are responsible for the limbs.

Causes

The attending physician should look for the causes of facial numbness and pain attacks. The nerve branch can become inflamed as a result of compression or due to failures in the circulatory system. Such problems are usually the result of internal failures and external stimuli. Neurologists often name the following causes of inflammation:

The appearance of a tumor or adhesions that compress the nerve branches;
Aneurysm (protrusion) of the arteries;
Dental pathologies (pulpitis, periodontitis, etc.);
Inflammatory process localized in the nasopharynx or in the jaw area;
Infection in the oral cavity;
The appearance of sclerotic plaques in the vessels that feed the facial nerve;
Getting a head injury;
Hypothermia.

Sometimes the appearance of a numb area and acute pain is provoked by other pathologies:

Mental disorders;
Cardiovascular pathologies;
Herpes;
Disruptions in metabolism and endocrine disorders;
Multiple sclerosis (demyelinating disease).

The triple nerve can also become inflamed due to hormonal changes, for example, in women during menopause. Sometimes the reason is hidden in a banal lack of nutrients.

Medical therapy

With inflammation of the trigeminal nerve, the symptoms and treatment at home are interconnected, because the main task is to relieve pain attacks and eliminate the cause of the problem. The course of drug therapy consists of the following tablets:

Drugs with an anticonvulsant effect help well with trigeminal neuralgia. Among the drugs from this group, carbamazepine is most often used. Due to its composition, the drug reduces the intensity and frequency of attacks. The effect becomes noticeable after about 2-3 days from the start of administration, and the duration of the course is selected individually;
In the early days, the treatment of inflammation of the trigeminal nerve at home takes place with the help of anti-inflammatory drugs like Ibuprofen;
Anesthetics and antispasmodics like Baclofen help to remove pain. In severe cases, the doctor will prescribe narcotic drugs that can only be bought by prescription;
To improve the mental state, drugs with a sedative effect are used, as well as antidepressants, such as Amitriptyline. You can buy it only by prescription;
Vitamin complexes with a large concentrate of B vitamins will help to strengthen the immune system and improve the general condition, and Neurobion is most often prescribed.

In addition to stopping seizures, it is necessary to eliminate the main problem, and for this, the following drugs are useful:

If the cause lies on a viral infection, for example, herpes, then antiviral drugs are prescribed by the type of Gerpevir;
If a patient has a demyelinating disease, then drugs are used to slow down the course of the pathology and improve the passage of a nerve impulse;
In atherosclerosis, medicines are used to dissolve cholesterol plaques like Atoris;
If the cause of the pathology is a protrusion of the artery wall, then often the treatment is carried out surgically.

Physiotherapy and folk methods

Physiotherapy goes well with a course of pills, because it accelerates the regeneration of damaged tissues and improves blood circulation. Doctors often prescribe the following procedures:

Ultraviolet irradiation (UVI). It serves to reduce pain;
Ultra high frequencies (UHF). This procedure is designed to eliminate pain and normalize blood circulation;
Electrophoresis with diphenhydramine and vitamins from group B. This remedy serves to reduce muscle spasm and improve the nutrition of nerve fibers;
laser therapy. It does not allow the nerve signal to pass through the damaged tissues and reduces the intensity of the pain attack;
Electricity. It reduces the intensity of attacks and increases the breaks between them.

Together with a course of physiotherapy, treatment with folk remedies can also be used. This includes various lotions and decoctions from medicinal herbs, for example, lemon balm, chamomile, hawthorn, oak bark, calendula, etc. They are usually prepared in a standard way. For this, you need to mix the main ingredient with water in a ratio of 1 tbsp. l. for 250 ml of liquid and put on fire until boiling. Then the broth is turned off and infused for 1-2 hours. The remedy is used depending on the selected components, but it is recommended to consult a doctor before use.

Treatment with leeches

Usually, leeches are placed in special clinics by experienced specialists and this treatment is called hirudotherapy. Reducing pain and reducing the inflammatory process is achieved due to the enzyme produced by leeches. These worms also help cleanse the walls of blood vessels and improve blood circulation.

During research, experts found that the bite of a leech activates immune system, as a result of which it is strengthened. After all, lymph comes out of the wound, therefore, the body begins to actively produce it.

This useful procedure has its own contraindications:

Pregnancy;
Low pressure;
Anemia;
Low blood clotting;
Individual intolerance to leeches.

Surgical treatments

With inflammation of the trigeminal nerve, the treatment lasts quite a long time (from 2 weeks to a year), but if there are no results after 4-5 months, then the doctor recommends surgery. The most commonly used surgical methods are:

Enlargement of the opening in the skull from which the nerves exit. An operation is performed in the region of the infraorbital canal;
microvascular decompression. During the procedure, the surgeon will move away all the vessels interfering with the nerve and, if necessary, remove them.

If a neoplasm is detected, then the operation is mandatory. After all, only by removing it can the inflammation of the trigeminal nerve be removed. In the case of a successful operation, pain attacks should no longer torment.

Sometimes it is difficult to understand how to treat inflammation of the trigeminal nerve and doctors can only reduce its conduction with the following procedures:

Rhizotomy. In this case, electrocoagulation is used to cut the damaged fibers;
balloon compression. During this operation, an air balloon is used to compress the ganglion of the facial nerve;
radiofrequency destruction. It is performed to eliminate the modified roots of the facial nerve.

Prevention

Inflammation of the triple nerve always proceeds with an abundance of pain attacks, but they can be avoided by observing preventive measures:

Do not overcool;
Strengthen immunity;
Try to avoid stress, as well as mental and physical overload;
Make the right diet
Timely treat emerging diseases, especially those related to the oral cavity and nasopharynx.

Forecast

Trigeminal neuralgia is an unpleasant pathological process, but not fatal. With a properly selected course of therapy and compliance with the rules of prevention, you can get rid of it. The duration of treatment depends on the degree of damage to the nerve tissue, but varies from 2-3 weeks to months. Gradually, the attacks will decrease in frequency and intensity of manifestations, and then they will completely disappear.

Any neuritis, including inflammation of the trigeminal nerve, is quite treatable if not delayed with it. Otherwise, the symptoms of the disease will worsen significantly and surgery may be required.

The information on the site is provided for informational purposes only, does not claim to be reference and medical accuracy, and is not a guide to action. Do not self-medicate. Consult with your physician.

What can cause inflammation of the trigeminal nerve: classification of causes and symptoms

Many of us do not even suspect what the trigeminal nerve is. This article will help you understand this difficult issue.

The trigeminal nerve is one of the types of nerves of the mixed type, which consists of 3 branches, 2 of which have only sensory fibers, and the 3rd has both sensory and motor fibers.

The trigeminal nerve is a mixed type of nerve, since it is characterized by the presence of both sensory and motor fibers. They, in turn, are of great importance for our body.

The motor branches that emerge from the pons are located next to the sensory ones, with each branch forming a specific trigeminal nerve root.

The motor and sensory root of the trigeminal nerve form its trunk, which is located in a hole at the top of the temporal bone pyramid. It is in this place that the trigeminal node is formed due to sensory fibers, and three branches depart from it: this is the ophthalmic branch, the maxillary and mandibular branches.

In turn, the trigeminal nerve performs certain functions, namely:

thanks to the trigeminal nerve, we can move the lower jaw;
he is responsible for the contraction of the muscles of the face;
the trigeminal nerve provides the perception of pain, touch, temperature;
it regulates the location of certain parts of the face, such as the lower jaw.

Classification of the causes of inflammation of the trigeminal nerve

In most cases, trigeminal inflammation affects the jaw, lower face, and around the eyes and nose.

Often, for most people, pain begins unexpectedly at first glance for no reason, but in fact there are a large number of reasons that can trigger the onset of inflammation of the trigeminal nerve.

Such reasons include the following:

flu;
syphilis;
tuberculosis;
chronic inflammation in the area of teeth, eye sockets, etc.;
hypothermia;
poisoning with toxins;
injuries or bruises.

As we can see, the causes of inflammation of the trigeminal nerve are quite diverse, and this list can still be supplemented with other elements.

Why is diabetic polyneuropathy of the lower extremities so dangerous, the treatment of which differs from therapy in other forms of the disease.

Primary and secondary causes

As for the primary causes of inflammation of the trigeminal nerve, they are most often infectious - allergic, and in turn are characteristic of such diseases as:

Bell's palsy;
prosoplegia;
herpes;
adenoviruses or enteroviruses.

Secondary causes include diseases that have already been transferred, for example:

Thus, for these reasons, inflammation of the trunk of the trigeminal nerve occurs, and inflammation can also affect the facial nerve itself due to infection.

There is another classification of causes that cause inflammation of the trigeminal nerve: internal and external causes.

Internal and external factors

External causes include:

hypothermia of a certain area of \u200b\u200bthe face;
injuries, bruises in the head and face;
infectious diseases in the teeth;
shingles virus.

Internal causes include:

multiple sclerosis is a disease in which damage to the nerve sheath occurs;
malnutrition of the nerve - this in most cases occurs in older people due to the deposition of cholesterol plaques on the walls of blood vessels;
compression of the nerve at the exit from the cranium.

Symptoms and signs of the disease

As we already know, the trigeminal nerve consists of sensory and motor fibers, therefore, in most cases, inflammation is characterized by severe pain or spasms of the masticatory muscles.

Inflammation of the trigeminal nerve has the following main symptoms:

radiating to the forehead or temple pain in the eye area;
sharp pain that is sudden;
tingling;
convulsions;
metallic taste;
increased lacrimation;
pupil dilation;
there may be numbness of the part that is inflamed;
in some cases, a rash may appear;
rhinorrhea;
redness of the inflamed area of the face.

Also among the signs of inflammation of the trigeminal nerve, pain can be distinguished:

when laughing;
pain with tactile touch;
pain with temperature change.

The photo shows the main symptoms of inflammation of the trigeminal nerve

In order for pain attacks not to recur, you need to move less, gesticulate less and not try to perform actions aimed at active movements.

This list of symptoms of inflammation of the trigeminal nerve of the eye is open, there are other signs by which this disease can be determined.

You should also not forget that each person has a disease that proceeds differently and the symptoms of inflammation of the trigeminal facial nerve are also different, so you do not need to self-medicate and try to diagnose yourself, as this often leads to disastrous results.

Diagnostic methods

As mentioned above, diagnosing this disease is quite simple, since it is characterized by a large number of symptoms that are very difficult to confuse with symptoms of other diseases.

But if everything is clear enough with the symptoms, then in order to find out the cause of inflammation of the trigeminal nerve, you need to conduct a series of clinical studies, for example:

Examination by a dentist. This is done in order to determine if the patient has a dental infection that can cause this disease;
Donating blood. This analysis allows us to find out if there are antibodies to the herpes virus in the blood;
Computed tomography of the head. This procedure is performed in order to determine if there is a tumor in the patient's head.
An X-ray of the vessels of the head using a contrast agent is done in order to find out if the patient has an aneurysm of the vessels.

Treatment of inflammation of the trigeminal nerve

Treatment of inflammation of the trigeminal nerve can be quite diverse and include etiotropic therapy, elimination of pain and, of course, treatment with traditional medicine.

Etiotropic therapy includes the following components:

the use of funds to restore the sheath of nerve fibers;
taking cholesterol-containing drugs;
surgical intervention;
antiviral intervention.

To reduce pain, the following remedies are used:

painkillers;
sedatives;
anti-inflammatory drugs;
antiepileptic drugs.

Surgical methods can also be used to treat neuralgia.

Today, several methods are known, but they remain highly controversial:

The first method is used only if the cause of the disease is in the wrong position of the vessels relative to the nerve. To do this, trepanation of the cranial fossa is performed and the correct position of the nerve relative to the vessels is restored.
In the second case, the radiofrequency method is used. In this case, high-frequency currents are passed through the patient's body towards the nerve. This method is more modern and requires much less recovery time.

Inflammation can also be treated with folk remedies, but this is more suitable in terms of prevention.

For example, there are such methods of treatment as rubbing black radish juice into the skin at the location of the nerve, taking yarrow tincture.

But due to the fact that the causes of the disease can be very diverse, it is better to consult a doctor initially.

Inflammation of the trigeminal nerve is a disease of one of the largest nerves, which is located in the area of \u200b\u200bthe teeth and face. This disease is known to physicians.

Video: Acute neuritis of the facial nerve

A neurologist talks about neuritis (inflammation) of the facial nerve. You will learn about what to do with inflammation of the facial nerve by watching this short medical video. We watch a medical video, listen to the advice of a doctor.

This section was created to take care of those who need a qualified specialist, without disturbing the usual rhythm of their own lives.

Trigeminal neuralgia - treatment. Inflammation of the trigeminal nerve - symptoms

An ordinary person, far from medicine, simply cannot know all the diseases that can be encountered at a certain stage of life. In this article, I want to talk about what trigeminal neuralgia is and how to deal with this problem.

What it is?

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

Neuralgia is a dull burning pain that occurs along the course of the nerve. As often as possible, people are faced not only with trigeminal neuralgia, but also with facial and intercostal neuralgia.
The trigeminal nerve is the most sensitive nerve in the face. Physicians distinguish such branches of the trigeminal nerve:

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

Causes

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

The nerve can be squeezed by improperly located vessels of the brain.
Problems with blood circulation in the vessels of the brain.
brain tumors.
Hypothermia of the face, head.
Infection of certain areas of the face. The trigeminal nerve can be irritated by constant sinusitis, and even caries.
Multiple sclerosis. Since in this disease, nerve cells are periodically replaced by connective tissue.

Symptoms

What signs can be used to diagnose "inflammation of the trigeminal nerve"? Symptoms of this disease are pain that can appear in any part of the face.

If the first branch is inflamed, the pain will be mostly in the eye area. "Give away" will be in the whiskey, the root of the nose, the frontal lobe.
If the second branch is inflamed, the pain will be concentrated mostly in the region of the upper jaw. The pain can “move” from the upper lip to the temple and back. It should also be said that this pain is easily confused with a toothache.
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 very clear how pain spreads if a person has inflammation of the trigeminal nerve. Symptoms in this disease can also be confused with symptoms of other diseases, such as, for example, temporal tendinitis or dental problems. That is why, at the first symptoms, it is important to seek medical help in order to make the correct diagnosis and prescribe competent treatment.

Types of pain

Pain in this disease can be of two main types:

Typical pain. It may quiet down from time to time. Shooting character, reminiscent of an electric shock. Pain occurs at the moment of touching certain areas of the face.
Atypical pain. Her character is constant, she amazes most faces. In this case, the treatment is more difficult and lengthy.

A few more words about pain

It is worth saying that only one pain sensation can make such a diagnosis as trigeminal neuralgia.

Most often, the pain will be one-sided.
Her attacks can be aggravated with the advent of a cold snap.
The frequency of pain attacks can be different: it varies from a couple of attacks per day to the onset of pain every 10 minutes.
Duration of attacks: a few seconds.
Pain can occur not only while touching the face, but also at the time of brushing your teeth, chewing food, and even talking.
Most often occurs suddenly.
It spreads along the branches of the branches of the trigeminal nerve.
Pain may increase over time, 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. On your own, you can make a mistake with the diagnosis, and compare the symptoms with a completely different disease. What will the doctor do?

Neurological examination with assessment of pain syndrome.
Palpation of the face. It is necessary to determine the degree of damage to the trigeminal nerve.
MRI - magnetic resonance imaging.
Computer diagnostics.

Treatment

If the patient has trigeminal neuralgia, the treatment of this disease can be carried out different ways. So, it can be conservative, that is, you can prescribe medications, physiotherapy. Treatment can also be radical. In this case, minimally invasive procedures are used, as well as surgical intervention.

Conservative getting rid of the problem

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

Antispasmodics. These are drugs that relieve pain, significantly facilitating the patient's condition. These medications can be given in isolation, but most often they are medications used together with anticonvulsants. Example: the drug "Baclofen" is attributed together with the drug "Phenytoin" or "Carbamazepine".
Anticonvulsants. To stop the 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, if necessary, can be increased. However, this can be done only 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 strength, drowsiness.

Alcohol blockade

If the patient has an inflamed trigeminal nerve, treatment can be carried out with the help of alcohol blockades. Their main goal: freezing the trigeminal nerve. This is followed by an analgesic effect. 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, the pain can disappear for a maximum of a day. However, she comes back anyway. If the nerve damage is quite strong, the effect of these injections is not so long. 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 drawbacks. This method is fraught with the following complications:

Bleeding.
Hematomas.
Vascular damage.
Damage to the nerve itself.

How will the process of alcohol blockade take place if the patient has inflammation of the trigeminal nerve on the face? Drugs for neuralgia, which the doctor can prescribe:

Conduction anesthesia. First, an injection of the drug "Novocain" (2%) is made, dosage: 1-2 ml.
And only after that the doctor injects a few ml of 80% alcohol, necessarily in combination with the Novocain preparation.

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?

"Release" the nerve from the pressure of the vessel on it.
The trigeminal nerve itself or its node can be destroyed. This is done in order to stop the pain syndrome.

It is worth saying that such operations are minimally invasive.

Bloodless surgery

If the patient has trigeminal neuralgia, treatment can be done with radiosurgery such as CyberKnife or GammaKnife.

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

There are many advantages to this type of treatment. First of all, it is a non-invasive intervention. There is no 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 another huge plus 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 deal with this disease

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

Vascular decompression. In this case, during surgery, the patient will be “released” the nerve. The doctor’s vessel itself can both be displaced and removed. 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.
balloon compression. In this procedure, the doctor inserts a catheter into the trigeminal ganglion, at the tip of which a small balloon is placed. It gradually inflates, which leads to the fact that the nerve bursts. This treatment is carried out using CT or MRI. Nuance: 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.
If the patient is affected by the trigeminal nerve, treatment can be carried out thanks to 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 a 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 most often used in the treatment of the elderly, as well as patients with multiple sclerosis. The effect of this procedure lasts quite a long time. Pain may appear at least after a few years.

ethnoscience

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

To prepare the medicine, it is necessary to chop the onion, potatoes and pickles, pour everything with diluted wine vinegar to the state of gruel. The resulting mass must be insisted for about 2 hours. At this time, we must remember that the medicine must be shaken. It is best to do this every 15 minutes. And only after that you can be treated with this remedy. Compresses are made from it, which are placed on the affected areas of the face twice a day - in the morning and in the evening. The compress is kept on the face for 1 hour.
If the patient has inflammation of the trigeminal facial nerve, juice obtained from black radish can be used for treatment. It just needs to be rubbed along the nerve into the skin. This must be done three times a day.
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, filtered. The medicine should be taken one tablespoon three times a day 10 minutes before the main meals.
If the trigeminal nerve is inflamed, treatment can be carried out with 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 afraid if the skin at the site of rubbing turns red and swells. The pain will soon subside, the burn will come down, and the problem will not disturb.
People say that ordinary boiled eggs help to cope with pain. If the patient has an inflamed trigeminal nerve, you need to boil one hard-boiled egg, peel it, cut it in half and apply it to the skin in those places where the pain is localized. Soon the disease will disappear.
Chamomile tea can help relieve pain. It is very simple to prepare it: 1 teaspoon of grass must be poured with a glass of boiling water, insist a little. The medicine is ready. Now tea must be typed into the mouth and kept there for a long time.

Violation of the branches of the trigeminal nerve in humans is caused by severe moral and physical discomfort. Sometimes the patient is not able to lead a normal life due to manifestations of facial convulsions. The disease provokes severe pain that expands to one part of the face. To reduce sensitivity, eliminate the pain syndrome, drug treatment of trigeminal neuralgia is carried out, as well as physiotherapy procedures, and even surgical intervention is possible.

The basis of the treatment of the trigeminal nerve are medications. According to the recommendations of the doctor, therapy with folk remedies is also possible.

The most common and effective tool is carbamazepine. It delivers the development of obstructive processes in the nerve roots, as a result of which the pain disappears.

It is necessary to use the tablets for about 2 months. Already for 1-2 days the effect of the drug will be noticeable. Immediately after taking the pain sensation is eliminated for a while. This remedy is quite toxic, so you will need the help of a doctor who will conduct a thorough analysis, as well as an individual agreement on the treatment regimen.

The limitation of Carbamazepine is pregnancy, lactation. It exhibits a toxic effect on the fetus. It should not be consumed by people with glaucoma, heart block, blood pathologies.

To relieve the pain syndrome of trigeminal neuralgia will help:

non-steroidal anti-inflammatory drugs (Ketons, Nimesil, Analgin, etc.), relieve pain;
anticonvulsants (Baclofen, Pantogam), the pain disappears for about 3 hours, is used to reduce the pulsation of nerve tissues, drowsiness is possible;
antihistamines (Diphenhydramine, Pipolfen), used to increase the therapeutic effect;
antipsychotics (pimozide), adjuvant therapy of the facial nerve;
tranquilizers are used (Diazepam, Tazepam); as an additional remedy for neuralgia, the popular medicine Glycine is used, the course of which takes a long time;
vasotonics (Cavinton, Trental, etc.), are used for conjugate diseases of the cerebral vessels;
vitamins of groups B, C, in the acute course of the disease, it is desirable to use in injectable form.

Trigeminal neuralgia is a rather complex pathology that cannot be treated with pills alone. Painkillers will improve the patient's condition, reduce excitability.

Physiotherapy

Physiotherapeutic measures will complement the treatment with drugs, as well as increase its effectiveness. The specialist will prescribe the necessary procedures in accordance with the stage of development of the disease, the intensity of pain, the available conjugate chronic diseases in a person.

If the trigeminal nerve is damaged, the following procedures can be applied:

Ultrasound. The action of ultrasound occurs on the area of the exit of the roots of the trigeminal nerve. The therapeutic course is 10 days for 1-3 minutes. to a certain area.
Magnetotherapy. This procedure normalizes metabolic processes in the middle of the cells of the body. Magnetic exposure helps to remove toxic substances, reduce inflammation, swelling, restore the function and position of nerve fibers, small vessels.
Electrophoresis. The influence of the current on the necessary zone produces the normalization of the functions of the necessary parts of the body. Treatment of neuralgia with electrophoresis based on medicinal plants provides a stable result (when additional treatment is correctly selected). Treatment with conservative methods helps only at the initial stage of the development of the disease.
Laser therapy. This procedure is one of the most effective. The action of the laser beam on the skin goes directly to the inflammatory site of the facial nerve. In this regard, the pain decreases, the general condition of the patient returns to normal, pain attacks appear less frequently.
Acupuncture. It is also considered an effective method, the effectiveness of which is guaranteed by the influence of thin needles on specific points of the face located near the facial nerve. However, the procedure should be carried out by a qualified specialist, since the effect on acupuncture points has a strong effect on the work of all body devices.

Surgery

When physiotherapy and medications do not provide the necessary help, the doctor suggests that the patient undergo an operation to remove the cause of the disease. Which surgery to choose is determined solely by the attending physician, based on the available data on the course of the disease.

The specialist may prescribe the following activities:

radiofrequency ablation. High temperature affects the trigeminal nerve, as a result, the nerve fiber is destroyed, and the pain begins to subside. The operation is performed under local anesthesia, the patient does not require long-term hospitalization. He can go home in a couple of hours and continue treatment with medicinal or folk remedies that the doctor will prescribe. The full result will be noticeable only after a month. Therefore, after surgery, the patient will feel pain for a long time.
Rhizotomy. The operation consists in the fact that they produce a rupture of the trigeminal nerve. Behind the ear, an incision is made in the skin, a branch of the trigeminal nerve is divided. It provides tangibility of certain areas of the face. Through this radical method, a positive result occurs.
Glycerin injections. It is considered an effective procedure that eliminates pain during inflammation of the facial nerve. With the help of a thin needle, the drug is introduced into the zone of division of the trigeminal nerve. Such injections deliver a long analgesic result, but it happens that relapses occur in the later stages.
microvascular decompression. It consists in the elimination or movement of the vascular plexuses in contact with the trigeminal nerve. This operation is carried out under general anesthesia neurosurgeons. The efficiency of this method reaches only 80%.

Folk recipes for the treatment of neuralgia

Drug therapy in conjunction with folk recipes only reduces the pain symptom in the region of the facial nerve, without helping to remove the root cause of the disease.

The most common prescriptions for trigeminal neuralgia are:

with severe pain, boil a hard-boiled chicken egg, cut it in half, apply to the affected area; when the egg cools, the pain should also decrease or completely disappear;
garlic oil is used for the treatment and prevention of various types of neuralgia; 1 st. l. oil is diluted in 0.5 liters of vodka; the resulting essence is rubbed on the temples, forehead 2 times a day, and the attacks should disappear;
1 st. l. peppermint is poured with 200 ml of hot water for 10 minutes. it is necessary to boil, then strain; use 100 ml in the morning and evening; this recipe eliminates pain in diseases of the stomach, gastritis, nervous shocks, neuralgic diseases;
for neuralgia, grated horseradish is used, applied to the affected area;
a few leaves of green geranium are placed on a small piece of linen; then this compress should be applied with leaves to the affected area, bandaged and wrapped with a woolen scarf; after 2 hours, the pain should subside; repeat the procedure 2-3 times a day;
1 tsp yarrow plants pour 1 stack. boiled water, insist and strain; consume from 1 tbsp. l. up to 1/3 stack. received infusion per day before meals;
you need 1 potato, pickled cucumber and onion; all this is finely chopped, 1 liter of diluted wine vinegar is poured, insist for 2 hours, sometimes shaking the contents; apply compresses to the painful area for 1 hour in the morning and at night;
4 tbsp. l. dry chamomile pour 200 ml of hot boiled water, boil for 10 minutes, strain; use 1/3 stack. three times a day before meals; has an anticonvulsant and sedative effect in trigeminal neuralgia;
with neuralgia, rheumatism, you can use willow bark; in 10 g of finely chopped bark add 1 stack. boiling water, then boil for 20 minutes over low heat, covered with a lid; when the broth has cooled, strain it; take 1 tbsp. l. three times a day.

It is worth noting that the abuse of treatment folk methods can adversely affect human health and lead to complications. All analgesic components of plants are caused by their special composition. Therefore, before using, you should consult a doctor in order to avoid further trouble.

For the most part, it refers to an independent disease, all manifestations of which are painful sensations that are born within the nervous system itself. In this case, the human nervous system serves not only as a controlling and ordering body, not only as a higher center that analyzes signals coming from the periphery, but also as a source of its own problems. It is to such “internal problems”, both of the central and peripheral nervous systems, that neuralgia belongs, both, and (including) and.

Nerve root compression

Also, compression of the root can be caused by a hard, spasmodic muscle lying next to the affected root of the segmental (intercostal nerve).

Concerning trigeminal neuralgia when people immediately have a question -. The node of this nerve (paired) for work is also taken out of the brain. This is done by nature for convenience: the sensitive innervation of the head end of the body, which evaluates food and is the first to recognize danger, is too important a matter to be left to perform this function by a small number of cells in the brain, to the detriment of its function.

Therefore, the trigeminal ganglion is located outside the brain, but still in the cranial cavity. It is relatively safe: it can most often be displaced by a tumor that can press this formation against the bones of the skull.

As can be seen from the figure, the trigeminal ganglion is located outside the brain

Therefore, such variants of neuralgia are called symptomatic: headache, more precisely, facial pain is a symptom of external influences (in this case, tumors).

Results at trigeminal neuralgia

Now we can answer the question in the title of the article “ What are the consequences of trigeminal neuralgia?“:

The outcome may be different: as a rule, a complete cure can rarely be achieved, even with. A good effect is one in which seizures are disturbed much less frequently: for example, before treatment, seizures occurred every 2-3 days, and after treatment - 1 time in 10 days.

Upon reaching a certain age (70 years and older), as a rule, attacks of neuralgia become weaker, and in old age it is almost not detected. As we already wrote, it is extremely rare.

In any case, the consequences of trigeminal neuralgia will be periodic pain attacks, which, of course, will affect the quality of life. But there is no blindness, deafness, paralysis and everything else that popular rumor ascribes to this unpleasant disease.

Therefore, the main thing that a patient can do is to undergo a planned and comprehensive examination on time in order to exclude symptomatic variants of neuralgia.

trigeminal neuralgia- This is a chronic inflammatory disease of the trigeminal nerve (the largest sensory nerve of the face), characterized by paroxysmal pain syndrome.

This disease is also called facial or trigeminal(from Latin trigeminus or trigeminal) neuralgia.

Some statistics!

Trigeminal neuralgia occurs in 40-50 cases per 100 thousand of the population, about 5 people per 100 thousand of the population fall ill annually.

According to statistics, women over 50 years of age are more likely to get sick. Young people get sick less often, a few cases of the disease in preschool children are described.

Some interesting facts!

The first descriptions of trigeminal neuralgia are found in ancient sources. So the Chinese healer Hua Tuo was the first to use acupuncture for this ailment, but this procedure did not cure, but only temporarily eliminated the pain syndrome. Hua Tuo was executed by the ruler of the Chinese Empire, who suffered from this ailment because the doctor was not with him, during the onset of an attack of facial pain. So this pain was unbearable for the commander.
Trigeminal neuralgia refers to idiopathic diseases, that is, diseases with an unexplained cause. There is a lot of controversy over what leads to this disease among scientists, but a consensus has not yet been found.
Symptoms of trigeminal neuralgia can resemble a toothache, which is why dentists are often the first to deal with this condition. In this case, patients indicate pain in an absolutely healthy tooth, such a tooth can be mistakenly removed.
Stressful situations and surgical interventions on the face and in the oral cavity contribute to a temporary (up to several months) subsidence of the pain syndrome in trigeminal neuralgia.
Habitual non-narcotic analgesics are not effective in the treatment of neuralgia, they can only temporarily reduce pain, with each dose they help less and less.
Frequent bouts of unbearable pain in trigeminal neuralgia can disrupt the mental state of the patient, leading him to depression, fear, aggressive states, psychosis.
An attack of pain in trigeminal neuralgia can cause even a light touch, for example, applying a cream to the face.

How do nerves work?

Nervous system- one of the most important and complex systems of the body, which regulates, controls and implements all the processes that occur in the human body. We cannot do anything: neither move, nor think, nor show emotions, nor breathe, nor resist foreign agents, and are not even able to reproduce without the participation of the nervous system.

The human nervous system, especially the brain, has not yet been fully studied and is a storehouse for new discoveries and Nobel Prizes. After all, it is practically impossible to predict a person's reaction to various stimuli at one time or another, even to fully imagine the capabilities of a person, to understand the compensatory and restorative capabilities of the brain after injuries, infections and other pathological conditions of the nervous system.

And the most important function of a person, carried out by the nervous system - the intellect, distinguishes and exalts us above other creatures of the planet Earth. A huge number of scientists are working on the creation of artificial intelligence, but at the moment this is not possible, the human nervous system is thought out by nature to the smallest detail and is unique.

The structure of the nervous system

central nervous system

The human central nervous system is brain and spinal cord.

The main functions of the central nervous system:

regulates the functioning of all organs and systems, coordinates their joint synchronous work,
provides an adequate response of the body to various factors of the world around us,
the implementation of mental functions, mind, thinking, emotions, and so on, which distinguishes us, humans, from other creatures.

The main structures of the brain:

bark brain,
large hemispheres brain (end brain),
diencephalon: thalamus, hypothalamus, epithalamus, pituitary gland,
midbrain: roof of the midbrain, peduncles of the brain, aqueduct of the midbrain,
back brain: pons, cerebellum, medulla oblongata.

Rice. Schematic representation of the main structures of the brain.

Peripheral nervous system

The peripheral nerves include the cranial and spinal nerves.

The main functions of the peripheral nervous system:

collection of information from the environment, as well as the internal state of human systems and organs,
transmission of impulses with information to the central nervous system,
coordination of the work of internal organs,
movement implementation,
regulation of the functions of the circulatory system and others.

Departments of the peripheral nervous system:

somatic nervous system- carries out movements and collects information from the outside and from the inside.
Autonomic nervous system:
- sympathetic nervous system activated at the time of stress, danger, reaction to environmental and internal factors;
- parasympathetic nervous system - activated during rest, rest and sleep;
- enteric nervous system responsible for the work of all parts of the gastrointestinal tract.

cranial nerves- nerves extending from the brain, mainly regulate the functioning of the organs and muscles of the head, neck, face.

According to their functions, the cranial nerves can be divided into:

sensory nerves- responsible for the perception and transmission of a nerve impulse to the brain by the sense organs (hearing, vision, smell, taste, sensitivity of the skin and mucous membranes);
motor nerves- responsible for the work of muscles;
mixed nerves- nerves that have sensory and motor functions.

There are 12 pairs of cranial nerves in humans. Each cranial nerve has its nuclei* in the central nervous system, located primarily in the diencephalon, midbrain, and hindbrain.

*Nuclei of cranial nerves- these are the formations of the nervous system that receive and transmit nerve impulses to the peripheral nervous system, namely the cranial nerves.

Nerves under the microscope

Neuron (nerve cell or neurocyte)- is a structural unit of the nervous system, these cells are highly specialized, capable of reproducing and transmitting nerve impulses, which are very similar in their characteristics to electrical ones.

Neurons vary in size depending on function and type, on average from 10 to 30 µm (minimum 3, maximum 120 µm).

"Nerve cells don't regenerate!" - true or myth?

How many times have each of us heard this expression from doctors, teachers, parents. But American scientists in 1999 partially debunked this myth. Elizabeth Gould and Charles Gross proved that the central nervous system produces thousands of new neurons every day throughout life, they suggest that due to these new cells a person improves memory, new skills and knowledge appear. That is, these are such sheets of white paper, on which each person writes something new for himself. Research is still being carried out in this direction, no one knows what they will lead the scientific world to, but most likely, these studies will turn our ideas about the work of the nervous system upside down. And, perhaps, new discoveries will help find effective treatments for diseases that are currently considered irreversible, such as multiple sclerosis, Parkinson's disease, Alzheimer's syndrome and others.

The structure of neurons

What is a neuron made of?

Processes dendrites- receive impulses from other cells, usually have a branched shape (like a tree, each branch is further divided into branches). A neuron usually contains a large number of dendrites, but in some cells this process may be single (for example, retinal neurons that transmit impulses from photoreceptors in the eye).
Neuron body (soma) with the nucleus and other organelles. The body of a neuron is covered with two layers of fat (lipid membrane), a protein layer and accumulations of polysaccharides (carbohydrates). Due to this structure of the cell membrane, the body of the neuron is able to process nerve impulses, and the impulse accumulates in it.
Soma also provides nutrition to the cell and the removal of waste products from it.
axon hillock- a section of the neuron body from which the process of the neuron axon departs, the function of this structure is the regulation of the transmission of a nerve impulse to the axon, that is, excitation of the axon.
axon process- a long process through which information is transmitted to other neurons. Each neuron has one axon, the longer it is, the faster the nerve impulse is transmitted. The terminal sections of the axons are divided into terminal branches, it is they that are connected to other nerve cells. The axon may or may not be myelinated.
myelin sheath is such an insulator of electricity, it is a membrane consisting of lipids and proteins. It consists of glial cells (Schwann cells in the peripheral nervous system and oligodendrocytes in the central nervous system), spirally envelops the axon. Between the glial cells there are gaps - Rvanier's interceptions, which are not covered with myelin. Thanks to myelin, electrical impulses are transmitted quickly through the nerves.

With disorders associated with the destruction of the myelin sheath, serious diseases develop - multiple sclerosis, diffuse sclerosis, encephalopathy, neuro-AIDS and other conditions.

Types of neurons, depending on the functions performed:

motor neurons - transmit impulses from the central nervous system to the peripheral nerves of the muscles,
sensory neurons - convert impulses from the environment or internal environment and transmit them to the central nervous system,
intercalary neurons - neurons that transmit impulses from one neuron to another, mainly intercalary neurons are represented by nerve cells of the central nervous system.

Nerve fibers- axons of neurons.

Nerves- accumulation (bundles) of nerve fibers.

Neuron connections

Neurons connect with each other to form synapses. Through them, one nerve cell (transmitting) transmits a nerve impulse to another nerve cell (receiving).

A synapse can also connect a nerve cell with cells of an innervated tissue (muscle, gland, organ).

The brain and spinal cord is a vast collection of interconnected neurons that have an extremely complex relationship.

Components of a synapse:

Axon of the transmitting neuron(its presynaptic ending), is able to stimulate the production of special chemical, impulse-transmitting neurotransmitters. Mediators of the nervous system (neurotransmitters, neurotransmitters) are produced in the synaptic vesicles of the presynaptic ending.
synaptic cleft through which momentum is transmitted.
The receptive part of the cell– or receptors on any receptive cell. Receptors can be located in the dendrite, axon or body of a neuron, on the membrane of sensitive cells in muscles, internal organs, sensory organs, glands, and so on.

Groups of neurotransmitters (neurotransmitters):

Monoamines: histamine, serotonin;
Amino acids: Gamma-aminobutyric acid (GABA), glycine, glutamic and aspartic acids;
Catecholamines: adrenaline, norepinephrine, dopamine;
Other neurotransmitters: acetylcholine, taurine, ATP, etc.

How is a nerve impulse transmitted?

nerve impulse- this is natural electricity that passes through electrical wires (nerves) in different directions and along certain trajectories. This electricity (impulse) is of chemical origin, carried out with the help of mediators of the nervous system and ions (primarily sodium and potassium).

Stages of formation and transmission of a nerve impulse:

excitation of a neuron.
The inclusion of the sodium-potassium pump, that is, sodium moves inside the excited cell through special sodium channels, and potassium moves out of the cell through potassium channels.
The formation of a potential difference between the membranes of the synapse (depolarization).
Formation of a nerve impulse - action potential.
Transmission of a nerve impulse along nerve fibers through synapses:
- secretion of neurotransmitters in the synaptic vesicles of the transmitting ending,
- the release of mediators (or substances that destroy them - in the process of inhibition) into the synaptic cleft,
- stimulation of depolarization of the perceiving cell (opening of sodium and potassium channels) - when the nerve fiber is excited, or hyperpolarization (closing of sodium-potassium channels) during inhibition ** ,
- impulse transmission further along the nerve fibers to the central nervous system or innervated organ.

** All processes of excitation of the nervous system always alternate with processes of inhibition, these processes are regulated in the axon and body of the neuron with the help of certain neurotransmitters that have an inhibitory effect.

The speed of transmission of a nerve impulse along nerve fibers covered with myelin is 2-120 m/s.

In addition to the transmission of nerve current through synapses, it is possible to directly propagate the impulse by contact, without the participation of mediators, with a dense arrangement of nerve cells.

Interesting! You can watch the video: “The incredible is around us. Nervous system".

Reflex- this is the reaction of the body to any stimulus from inside or outside the body. The central nervous system is necessarily involved in this process.

Reflex is the basis of the functioning of the nervous system, almost all nervous processes take place with the help of reflexes.

During the reflex, the nerve impulse passes through the reflex arc:

receptors of certain cells, organs and tissues,
sensory nerve fibers form and transmit nerve impulses from the innervated organs,
analysis of impulses in the central nervous system,
motor nerve fibers transmit impulses to the innervated organs - a response to an irritant.

Reflexes are:

conditional,
unconditional.

The higher nervous system, the cerebral cortex, necessarily takes part in the conditioned reflex (decisions are made there), and unconditioned reflexes are formed without its participation.

These reflexes develop as an automatic response to external and internal factors. Unconditional reactions exercise a person's ability to self-preservation, adaptation to environmental conditions, reproduction, preservation of homeostasis - the constancy of the internal state of the body. They are genetically determined and passed down from generation to generation.

Examples of unconditioned reflexes: sucking breast milk a newborn baby, sexual, maternal and other instincts, blinking at the threat of eye injury, coughing and sneezing when foreign particles enter the respiratory tract, and so on.

Trigeminal nerve

The trigeminal nerve is the 5th cranial nerve. It got its name because it contains three branches:

ophthalmic (upper) branch,
maxillary (middle) branch,
mandibular (lower) branch.

Before the exit of the trigeminal nerve from the skull, the nerve forms a large ganglion - the trigeminal ganglion ***.

Characteristics of the trigeminal nerve

Parameters	Characteristic
Parameters	ophthalmic nerve	maxillary nerve	Mandibular nerve
Type of nerves	Sensitive	sensitive	mixed nerve, contains sensory and motor fibers
What is innervated?	The skin of the frontal, temporal and parietal regions, the back of the nose, eyelids (upper), part of the nasal mucosa and sinuses, eyeball, partially lacrimal glands, partially meninges.	Skin of the eyelid (lower), upper lip and side of the face, upper teeth	Sensitive fibers- skin of the lower jaw area, oral cavity (mucous membrane of the cheeks, sublingual region, partly of the tongue) alveoli of the teeth, salivary glands, drum strings of the ear and dura mater. motor fibers- chewing muscles of the face, namely: digastric muscle (located in the hyoid region), pterygoid and temporal muscles.
Main functions	Skin sensitivity, tear regulation, meningeal sensitivity	Skin sensitivity	sensitivity of the oral mucosa and skin, sensitivity of the meninges, innervation of teeth participation in the act of chewing, innervation of the salivary glands, The perception of sounds by the drum string is a sensitive organ of the ear.
Place of exit from the skull	The outer wall of the orbit.	rounded hole - located under the orbit.	Foramen ovale - located under the eye socket.
Main branches of the nerve	lacrimal nerve, frontal nerve, nasopharyngeal nerve. Rice. #1	nodal branches, zygomatic nerves: zygomaticotemporal and zygomaticofacial, infraorbital nerves (one of the branches is the superior and posterior superior alveolar). Rice. #1	meningeal branch, chewing nerve, deep temporal nerves. pterygoid nerves, buccal nerve, ear-temporal, lingual, inferior alveolar. Rice. #2
Nerve nodes (ganglia) formed by the trigeminal nerve**	Eyelash knot: oculomotor nerve (III pair of cranial nerves), nasopharyngeal nerve.	Pterygoid node: nodal branches, sympathetic and parasympathetic branches of the large and deep stony nerves (branches of the intermediate nerve related to the cranial nerves).	Ear node: small stony nerve (branch of the glossopharyngeal nerve - IX pair of cranial nerves), mandibular nerve. Submandibular node: lingual nerve (branch of the mandibular nerve), branches that innervate the salivary glands drum string fibers.
nuclei in the brain	motor fibers the trigeminal nerve is located in the pons (hindbrain) - trigeminal motor nuclei. Sensitive fibers The trigeminal nerve passes through the legs of the brain, is represented by sensory nuclei in the brain: upper sensory tract nuclei, located in the pons of the brain, nuclei of the spinal cord located in the medulla oblongata nuclei of the mesencephalic tract are located in the midbrain near the aqueduct and partly in the pons of the hindbrain.

***Nerve nodes or ganglia- an accumulation of nervous tissue, containing nerve fibers and nerve centers, connects two or more nerve fibers to each other, receives impulses both from the endings and from the central nervous system (ascending and descending flows).

Rice. No. 1: The ophthalmic and maxillary nerve and their branches.

Rice. No. 2: Mandibular nerve and its branches.

Causes of trigeminal neuralgia

According to the mechanism of occurrence of trigeminal neuralgia, this pathology can be primary or true (isolated lesion of only the trigeminal nerve) or secondary (manifestation of neuralgia as a symptom of systemic diseases of the nervous system).

The exact cause of the development of trigeminal neuralgia has not been clarified, as mentioned above, it refers to idiopathic diseases. But there are factors that most often lead to the development of this disease.

Factors that contribute to the development of trigeminal neuralgia:

Compression of the trigeminal nerve in the skull or its branches after leaving the skull:
- vasodilatation of the brain: aneurysms (pathological expansion of blood vessels), atherosclerosis, hemorrhagic and ischemic strokes, increased intracranial pressure as a result of osteochondrosis cervical spine, congenital anomalies in the development of blood vessels, and so on - the most common cause of the development of trigeminal neuralgia,
- tumor formations brain or facial area along the branches of the trigeminal nerve,
- injury and post-traumatic scars
- injuries in the jaw-temporal joint,
- overgrowth connective tissue (adhesions) as a result of an infectious inflammatory process, sclerosis with damage to the myelin sheath of nerve fibers.
- congenital anomalies development of the bone structures of the skull.
Viral nerve damage: herpetic infection, poliomyelitis, neuro-AIDS.
Diseases of the nervous system:
- multiple sclerosis,
- children's central paralysis (CP),
- meningitis, meningoencephalitis (viral, tuberculosis),
- encephalopathy due to head injuries, infectious processes, hypoxia (lack of oxygen in the brain), lack of nutrients,
- brain tumors and circulatory disorders in the nuclei and fibers of the trigeminal nerve, and so on.
Odontogenic causes(related to teeth):
- "failed" filling or extraction of teeth or other surgical interventions in the face and oral cavity.
- reaction to anesthesia of the canals of the teeth,
- jaw trauma with damage to the teeth,
- dental flux.

Factors that increase the risk of developing trigeminal neuralgia:

age over 50 years,
mental disorders,
chronic fatigue ,
stress,
hypothermia of the face (for example, in a draft),
avitaminosis (lack of B vitamins),
metabolic disorders: gout, diabetes mellitus, thyroid disease and other endocrine pathologies,
helminthiases (worms),
fasting, malabsorption of nutrients in the intestines, bulimia, anorexia,
inflammation with swelling of the mucous membrane of the maxillary and other paranasal sinuses (chronic sinusitis),
inflammatory processes and ulcers (abscesses, phlegmon) in the oral cavity - gingivitis, pulpitis,
suppuration of the bones of the skull, especially the jaws (osteomyelitis),
acute and chronic infectious diseases with severe intoxication: malaria, syphilis, tuberculosis, brucellosis, botulism, tetanus, and so on.
autoimmune diseases,
severe allergic diseases.

Mechanism of development (pathogenesis) of trigeminal neuralgia

Many scientists around the world have been discussing the pathogenesis of the development of trigeminal neuralgia for many years. Depending on the causes that contributed to the occurrence of trigeminal neuralgia, two theory of the mechanism of its development:

And although there are “dark spots” in each theory, it is assumed that both mechanisms for the development of pain syndrome take place, that is, they sequentially follow each other. That is why the treatment of trigeminal neuralgia should be comprehensively aimed at restoring the myelin sheath of nerve fibers and inhibiting nervous processes in the brain.

Symptoms of trigeminal neuralgia

The main symptom of trigeminal neuralgia is pain in the face, but there are other manifestations and complications of this disease that do not cause such discomfort as unbearable pain, but may additionally point to trigeminal neuralgia.

Symptom	How is it manifested?	When does the symptom occur?
Pain in the face	Pain syndrome usually manifests itself in only one half of the face. The pain is paroxysmal or it is also called paroxysmal, attacks are replaced by periods of calm. The pain is unbearable, shooting in nature, it is often compared with electric shock. The patient at these moments freezes in the position in which the attack began, tries not to move, clamps his hands at the site of pain localization. Attacks of pain usually last from a couple of seconds to several minutes. Quiet periods can range from a few hours to several months. Sometimes, with an atypical course or a long-term course of the disease, pain in the face and head is almost permanent. With the duration of the disease, the duration of the attacks increases, and the period of remission is shortened.	Pain usually appears after exposure annoying factors. There are zones on the face, the so-called trigger zones (in the literature you can find the term algogenic areas), with a slight irritation of which a pain attack can begin. At the same time, a rough impact on these points during an attack often leads to its relief (cessation). Localization of trigger points is individual: lips, nasal wings, brow arches, middle part of the chin the junction of the jaws (maxillotemporal joint), cheeks, external auditory canal, oral cavity: teeth, inner cheeks, gums, tongue. Pain can occur both with strong blows and other gross factors of irritation of the area of \u200b\u200bthese points, and with minor irritations of trigger zones: cry, smile, laugh, talk, chewing, eating, change in air temperature, draft, yawning, sneezing, teeth cleaning, washing, applying cream, make-up, shaving and so on. Rice. Possible trigger zones in trigeminal neuralgia.
	Pain localization**** Temporoparietal region of the head, eyelids, and the area around the eyeball, nose, head as a whole.	With damage to the ophthalmic branch of the trigeminal nerve.
	Upper teeth, upper jaws, upper lip and cheek.	With damage to the maxillary branch of the trigeminal nerve.
	Lower teeth, lower jaw, lower lip, anterior parotid region.	With damage to the mandibular branch of the trigeminal nerve.
	entire half of the face	With the defeat of all branches of the trigeminal nerve and with the central cause of neuralgia (brain tumors and so on).
Redness of the face and sclera, increased salivation, lacrimation, the appearance of mucous discharge from the nose	These symptoms are localized on the affected side, appear during a painful attack.	Hyperemia of the face and increased production of the salivary, lacrimal glands and mucous glands of the nose are associated with disorders of the autonomic nervous system, the branches of which are part of the sensory fibers of the branches of the trigeminal nerve.
Twitching of facial muscles	Muscle tremor is similar to mild localized convulsions or nervous tics, occurs against the background of pain syndrome. In this case, chewing and facial muscles are involved. There may be a narrowing of the palpebral fissure on the affected side, associated with spasm of the eyelids.	Muscle twitching is associated with a reflex spread of increased excitability to the motor fibers of the trigeminal nerve and other cranial nerves innervated by the muscles of the face. Photo of a patient during an attack of trigeminal neuralgia.
Mental disorders	The patient becomes irritable, there is a feeling of fear, anxiety. When laughter, conversation, eating leads to the development of pain, the patient closes, is silent, refuses to eat. In severe cases, suicidal tendencies (the desire to commit suicide) can be observed.	Mental disorders in a patient occur against the background of frequent debilitating bouts of unbearable pain, the duration of the disease (years), the appearance of seizures against the background of minor irritation factors of trigger zones. Patients develop apathy, psychosis, phobias, depression, and so on.
Loss of sensation in the face (paresthesia)	Feeling of tingling, crawling on the affected side. There may be a dull aching pain, reminiscent of toothache from caries and pulpitis (which leads patients to the dentist). Sometimes there is a lack of sensitivity of the skin along the branches of the trigeminal nerve.	This symptom occurs in a third of patients and is usually a harbinger of an approaching pain attack (a few days or a few months before the paroxysm). Paresthesias are associated with widespread damage to the myelin sheath of nerve fibers, which leads to a violation of their sensitivity in the direction of increased excitation and impaired conduction of the nerve impulse along the sensory fibers of the nerve.
Violation of blood circulation and lymphatic outflow (trophic changes)	facial asymmetry, raised corner of the mouth (grin), drooping of the eyebrow, upper eyelid, muscle tension on the healthy side of the face, dry skin, peeling, appearance of wrinkles loss of eyelashes, eyebrows, tooth loss (periodontal disease), baldness in the temporal and frontal region, local graying of hair, weakness of the chewing muscles.	Trophic disorders along the course of the trigeminal nerve may occur after several years of the disease. Due to a violation of the innervation of the muscles and skin of the face by the trigeminal nerve, prolonged and frequent pain attacks, there is a violation of blood circulation and lymph flow in the affected half of the face. This leads to tissue malnutrition (lack of oxygen and nutrients). In order not to irritate the trigger zones, the patient spares the diseased side of the face: chews on the healthy side, does not smile, does not open his mouth wide, and so on. This eventually leads to atrophy of the masticatory and facial muscles (decrease in muscle tissue, decrease in their functions), which in turn also leads to a violation of the trophism of the muscles and skin of the face. Photo of a patient with atrophy of facial muscles on the right side.

****Trigeminal neuralgia usually develops on one side and is most often right-sided. With the course of the disease, the localization of pain does not change. Only with severe pathologies of the brain is it possible over time to spread the process to the second half of the face.

Diagnosis of trigeminal neuralgia

Examination by a neurologist

Anamnesis (history) of life: the presence of factors and diseases that could cause trigeminal neuralgia (tumors, vascular pathology of the brain, previous diseases, surgical interventions in the oral cavity or on the face, and so on).
Disease history:
- the onset of the disease is acute, sudden, patients clearly remember when, where and under what circumstances the first attack of paroxysmal pain began,
- attacks of pain alternate with periods of remission,
- pain syndrome provokes even a slight irritation of one of the trigger zones of the trigeminal nerve,
- one way process
- pain is not stopped by anti-inflammatory and analgesic drugs.
Complaints to attacks of acute unbearable pain that appears suddenly after irritation of trigger zones, and the appearance of other symptoms of trigeminal neuralgia (given above in the table).
Objective examination during the interictal period:
- General state usually satisfactory, consciousness is preserved, neurotic reactions are possible, a violation of the mental state of the patient.
- When examining the patient won't let you touch your face in the area of trigger zones, he himself points to them, without bringing his finger to the skin or mucous membrane.
- The skin is often unchanged, with a severe long-term course of the disease, dry skin, the presence of peeling, folds and wrinkles, facial asymmetry, drooping of the upper eyelid and other symptoms of facial muscle atrophy are possible. Visible mucous membranes are not changed.
- Sometimes there is a violation of the sensitivity of the skin of the face (paresthesia).
  From the internal organs(cardiovascular, respiratory, digestive and other body systems), usually no pathological changes are detected during the examination.
- Neurological status in patients with trigeminal neuralgia without pathology of the central nervous system is not changed. There are no pathological reflexes, signs of inflammation of the meningeal membranes (meningeal signs).
In the pathology of the brain, signs of focal lesions may appear (for example, drooping of the upper eyelid or ptosis, pupillary difference or anisocoria, symptoms of a violation of the patient's orientation in space, changes in the frequency and quality of breathing, intestinal paresis and other specific neurological symptoms of damage to the middle and hindbrain) . Identification of these symptoms requires further mandatory instrumental examination of the brain.
Objective examination of the patient during an attack of paroxysmal pain:
- Pain occurs after exposure to the trigger zones of the trigeminal nerve, and the pain syndrome itself spreads only along the branches of the trigeminal nerve.
- Patient posture: freezes or tries to stretch the muscles of the face with his hands, does not answer questions or answers in short phrases. At the same time, the patient has a very frightened and suffering look.
- On the skin perspiration (sweat) appears on the face, the skin of the diseased side of the face and the mucous membrane of the sclera turn red, lacrimation is possible, the patient often swallows due to increased salivation, mucous discharge “stream” may appear from the nose.
- Possible appearance convulsive twitches mimic muscles of the face on one side.
- Breath the patient is getting smaller or more frequent.
- Pulse increases (more than 90 per minute), blood pressure does not change, or slightly increases.
- When conducting novocaine blockade trigeminal nerve (the introduction of novocaine along the branches of the trigeminal nerve, basically, these are those trigger points), the attack temporarily stops.

The diagnosis is made on the basis of specific complaints, the presence of trigger zones, the localization of pain along the branches of the trigeminal nerve, the appearance of the above symptoms during an attack, an objective examination, and instrumental diagnostic data.

Instrumental research methods

Magnetic resonance imaging (MRI) of the brain and spinal cord
MRI– most informative a method for studying the structures of the brain, its vessels, nuclei and branches of the cranial nerves.

This method is visual (that is, we get an accurate three-dimensional image on the screen and on paper), however, unlike x-ray methods, MRI is based on magnetic, and not on radiation. That is, it is safe for the patient.

If trigeminal neuralgia is suspected, MRI is necessary to detect or exclude brain tumors, vascular disease, the presence of diffuse or multiple sclerosis, and others. possible causes the development of the disease.

For a more accurate study of the pathologies of the cerebral vessels, MRI is used with the introduction of a contrast agent into the vessels (angiography).

Disadvantages of the method:

high cost of research;
contraindications: the presence of metal objects in the body (the remains of fragments, pacemakers, metal plates, which are used for osteosynthesis in complex bone fractures, metal dentures, crowns), severe psychological illness, claustrophobia.

Computed tomography (CT)

CT- X-ray diagnostic method that allows you to visualize the structures of the brain and spinal cord in layers. In terms of information content, it is slightly inferior to magnetic resonance imaging, since MRI allows you to form a three-dimensional image, and CT - a two-dimensional image. CT can detect diseases of the central nervous system that could lead to the development of trigeminal neuralgia.

The main disadvantage of computed tomography is a large beam (radiation) load and high cost (but the CT method is more accessible and cheaper than MRI).

Electroneurography

Electroneurography - an instrumental method for studying the nervous system, which makes it possible to determine the speed of conducting an electric current (impulse) along the nerve fibers of peripheral nerves.

What does electroneurography reveal?

presence of nerve damage
the level of damage (that is, where exactly),
pathogenesis of the lesion (damage to the myelin sheath or damage to the axon),
prevalence of the process.

What changes can be detected in trigeminal neuralgia?

demyelination(damage to the myelin sheath of axons), which is a key factor in the pathogenesis of trigeminal neuralgia,
other nerve changes characteristic of other nerve lesions, allowing to differentiate diseases of the nervous system.

Electroneuromyography (ENMG)

ENMG- a kind of electroneurography, allows you to study the speed of passage of electric current through the peripheral nerve with a parallel study of the reaction of the muscles that are innervated by this nerve.

In addition to those parameters that electroneurography reveals, ENMG reveals pain tolerance and the sensitivity threshold of possible trigger zones of the trigeminal nerve, as well as the degree of contraction of muscle fibers in response to increased nerve excitation.

Electroencephalography (EEG)

EEG- a method of diagnosing the nervous system, in which a special device electroencephalograph registers the biological electrical activity of the brain, depicting them in the form of curves. This method allows you to identify structures through which the passage of impulses is impaired.

What is revealed by EEG during a paroxysmal attack of trigeminal neuralgia?

changing curves by synchronized or non-synchronized type,
signs of epileptic foci in the hindbrain and midbrain, at the locations of the nuclei of the trigeminal nerve.

Additional consultations of narrow specialists in trigeminal neuralgia

ENT - it is necessary to identify and, if necessary, cure chronic diseases of the nasopharynx.
Neurosurgeon - if a pathology of the central nervous system is detected, which could lead to the development of neuralgia, it is necessary to resolve the issue of the need for surgical treatment.
Dentist - for differential diagnosis of trigeminal neuralgia with dental diseases and, if necessary, sanitation of the oral cavity.

Laboratory research methods

With trigeminal neuralgia, laboratory diagnostics is not very informative, usually the biochemical parameters of blood and other biological fluids are normal. At the moment, there are no specific laboratory indicators indicating neuralgia, in general, including trigeminal neuralgia.

But against the background of taking medications for the treatment of neuralgia, it is necessary to control their tolerance. To do this, periodically conduct biochemical studies of the liver, a general analysis of urine and blood.

If there are symptoms of inflammation of the meningeal membranes (meningeal signs), it is necessary to perform a lumbar puncture, followed by a laboratory study of the cerebrospinal fluid (cerebrospinal fluid). This is necessary to rule out meningitis.

With herpetic lesions of the trigeminal nerve, it is necessary to control the level of immunoglobulins A, M, G to herpes types I, II, III.

Treatment of trigeminal neuralgia

Treatment of trigeminal neuralgia should be complex:

elimination of the causes that provoked the development of trigeminal neuralgia.
decrease in excitability of the central nervous system;
stimulation of the restoration of the myelin sheath of the damaged trigeminal nerve - at the moment there are no means to completely restore myelin, on the development of such effective drug scientists from all over the world are working, but some measures are being taken to stimulate the restoration of the myelin sheath;
physiotherapeutic effect on the branches of the trigeminal nerve and trigger zones.

Drug treatment of trigeminal neuralgia

Drug group	A drug	Mechanism of action	How to apply?
Anticonvulsants(selection of the drug and its dose is carried out individually)	Carbamazepine (finlepsin)	Effects of taking anticonvulsants: antiepileptic, psychotropic effect, relief and prevention of pain attacks in trigeminal neuralgia. Their main action is the stabilization of the sodium-potassium channels of the axon membrane that transmit nerve impulses. This reduces the excitability of the nerve fibers of the trigeminal nerve and its nuclei in the middle and posterior parts of the brain. Other effects: release of glutamate (a neurotransmitter that contributes to the inhibition of a nerve impulse) and inhibition of the production of neurotransmitters that contribute to the excitation of nerve fibers (dopamine and norepinephrine). Attention! Anticonvulsants are psychotropic drugs and have many side effects, so they are available in pharmacies only by prescription.	The drug is administered gradually from small doses, then the dosage is increased. Treatment begins with 100-200 mg 2 times a day, then adjusted to 400 mg 2-3 times a day until the pain attacks stop. Later, you can reduce the dose to maintain the therapeutic effect to 100-200 mg 2 times a day. The treatment is long.
	Phenytoin (difenin)		Start with a dose of 3-5 mg per kg per day, then increase the dose to 200-500 mg per day. The dose is taken once or divided into 2-3 doses, only after or during meals. The treatment is long.
	Lamotrigine		The initial dose is 50 mg 1 time per day, then the dose is adjusted to 50 mg 2 times a day. The treatment is long.
	Gabantin	The mechanism of action of this drug is not known, its high efficacy in trigeminal neuralgia has been experimentally proven.	The initial dose is 300 mg per day, the maximum is 1800 mg per day. The drug is taken in 3 doses.
	Stazepin		Start with 200 mg per day, increase the dose to 600 mg per day. Taken in 3 doses.
Muscle relaxants	Baclofen (Baclosan, Lioresal)	Baclofen is effective in the treatment of neuralgia by stimulating the production of the neurotransmitter GABA (gamma-aminobutyric acid). Effects of the use of muscle relaxants: inhibition of excitability of nerve cells, decrease in muscle tone, analgesic action.	The initial dose is 15 mg for 3 doses, then gradually it is increased to 30-75 mg per day for 3 doses.
Muscle relaxants	Mydocalm	stabilizes the sodium-potassium channels of the axon membrane, contributes to the inhibition of the passage of nerve impulses along the nerve fibers, prevents the passage of calcium into the synapses, improves blood circulation in the head, has an analgesic effect	The initial dose is 150 mg per day for 3 doses, the maximum dose is 450 mg per day for 3 doses.
Vitamin preparations	B vitamins (neuromultivit, neurovitan and other complexes)	antidepressant action, reduces the adverse effects of external factors on nerve cells, participates in the processes of gradual restoration of the myelin sheaths of axons and many other effects in relation to both the peripheral and central nervous systems.	1 tablet 3 times a day with meals.
Vitamin preparations	Omega-3 Unsaturated Fatty Acids (Bio Supplement)	Unsaturated fatty acids are the building blocks of myelin.	1-2 capsules per day with meals.
Antihistamines	Diphenhydramine, pipalfen	Enhance the effect of anticonvulsants.	Diphenhydramine 1% 1 ml at bedtime at night, Pipalfen 2.5% - 2 ml at bedtime as an injection.
Sedative and antidepressant drugs	Glycised (glycine)	Glycine is an amino acid that is a neurotransmitter that inhibits the processes of excitation of the nervous system. It has a calming, anti-stress effect, normalizes sleep.	Dissolve 2 tablets 3 times a day, under the tongue.
	Aminazin	Aminazine blocks receptors that receive impulses from transmitting nerve fibers. Due to this, the drug has a sedative effect and reduces psychotic reactions in acute and chronic psychoses.	20-100 mg every 4-6 hours inside. Injection administration of the drug is necessary for acute psychotic reactions. A single dose of 25-50 mg is administered, if necessary, the drug is administered repeatedly. Reception of this drug is continued until the mental state of the patient is normalized.
	Amitriptyline	It has an antidepressant effect by regulating the release of neurotransmitters.	Initial dose: 75 mg in 3 doses, then increase the dose to 200 mg in 3 doses. The drug is recommended to be taken with food.

In severe trigeminal neuralgia, constant pain, even narcotic drugs (sodium oxybutyrate, cocaine, morphine, and so on) are recommended.

Previously, blockade of the branches of the trigeminal nerve with 80% ethyl alcohol (alcoholization), glycerin and novocaine was widely used. However, at the moment, it has been proven that, despite the rapid analgesic effect, these procedures contribute to additional traumatization and destruction of the myelin sheath of the trigeminal nerve, which later (after six months) leads to the progression of the disease with short remissions and prolonged pain attacks.

Be sure to spend correction of those conditions that may have led to the development of the disease:

treatment of ENT pathology,
therapy of vascular diseases of the brain,
adequate sanitation of the oral cavity,
antibacterial (or antiviral) and immunocorrective treatment infectious diseases,
prevention of proliferation of connective tissue (scars) after injuries, surgical treatment and infectious processes, for this it is effective to prescribe biostimulants (aloe extracts, placenta, FiBS), short courses with small doses of glucocorticosteroids (hormones) and physiotherapy procedures,
normalization of metabolism, with its violations (diet, vitamin therapy, hormonal correction, and so on),
other measures, depending on the causative diseases and conditions.

Surgical treatment for trigeminal neuralgia

Surgical treatment of trigeminal neuralgia is recommended if it can effectively solve problems with minimal risks of postoperative complications. They also offer facilitating surgical manipulations in the absence of a clinical effect from the drug therapy performed (after 3 months of no positive results).

Prompt solution of problems that caused neuralgia:
- removal of brain tumors(the volume of the operation is determined by the type, localization and prevalence of the tumor process),
- microvascular decompression- displacement or resection (removal) of dilated vessels that put pressure on the trigeminal nerve or its nuclei,
- expansion of the narrowed infraorbital canal(place of exit of the trigeminal nerve) - low-traumatic surgery on the bones of the skull.
  With the effective elimination of the causes that caused compression of the trigeminal nerve, often attacks of trigeminal neuralgia disappear, the outcome is recovery.
Surgery, aimed at reducing the conduction of the trigeminal nerve:
- Cyber Knife– modern effective treatment of trigeminal neuralgia. At the same time, unlike other traumatic operations, the risk of complications is minimal (5% on average). Cyber Knife is a type of radiosurgery that does not require punctures, incisions or other traumatic manipulations. It is possible to conduct outside the hospital hospital (outpatient).
  This method is based on the effect of a thin beam of radiation on the site of increased excitability of the nerve fibers of the trigeminal nerve or its nucleus.
- Gamma Knife like CyberKnife, a radiosurgery method in which beams of radiation destroy the trigeminal ganglion. It also has a low risk of complications. In terms of its effectiveness, Cyber Knife is inferior.
- Trigeminal ganglion balloon compression a catheter is inserted through the skin into the region of the trigeminal nerve node, through which a balloon is installed and filled with air. This balloon compresses the ganglion, eventually destroying the branches of the trigeminal nerve, which eliminates the conduction of nerve impulses to the central nervous system. This method has a temporary effect and can lead to the development of complications (numbness of the face, distortion of facial expressions, violation of the act of chewing).
- Resection of the trigeminal ganglion- a complex traumatic operation that requires craniotomy, removal of the ganglion by excision with a scalpel and a long postoperative recovery, and also has a high risk of complications.
- Other types of surgeries aimed at removing the trigeminal ganglion or branches of the trigeminal nerve are traumatic and often lead to complications.

The choice of surgical treatment depends on:

capabilities of the medical institution and surgeons,
financial capabilities of the patient (radiosurgery methods are quite expensive),
the presence of comorbidities,
the general condition of the patient,
causes that led to the development of neuralgia,
the presence of individual indications and contraindications for a certain type of operation,
patient response to drug treatment
the risk of postoperative complications and so on.

Physiotherapy for trigeminal neuralgia

Physiotherapy- effective measures for the relief of pain in trigeminal neuralgia. Depending on the degree of damage, the frequency of relapses, the cause that caused neuralgia, one or another method of physical impact on the trigeminal nerve or its nuclei is prescribed.

Physiotherapy methods

Method	the effect	Method principle	Duration of treatment
Ultraviolet irradiation (UVR) of the face and neck	Removal of pain syndrome.	Ultraviolet irradiation (namely medium wave) promotes the release of neurotransmitters that inhibit the excitation of nerve fibers and natural analgesics.	10 sessions
laser therapy	Relief of pain syndrome inhibition of nerve impulse conduction along the nerve fibers of the trigeminal nerve.	The laser affects the localization of each branch of the trigeminal nerve, as well as the nodes formed by this nerve. Laser irradiation depresses the sensitivity of nerve fibers.	On average, 10 procedures of 4 minutes are recommended.
UHF	Removal of pain attack, improvement of microcirculation in case of atrophy of mimic and masticatory muscles.	Exposure to ultra-high frequencies contributes to: absorption of energy by the tissues of the affected areas, which is manifested by the release of heat from them, improve blood circulation, lymph flow, partial normalization of sodium-potassium channels of the membrane of nerve fibers that transmit nerve impulses.	15-20 sessions of 15 minutes
electrophoresis	analgesic effect, muscle relaxation.	Electrophoresis - the introduction of medicinal substances with the help of an electric current directly into the desired area of \u200b\u200bnerves. For pain relief, enter: novocaine, diphenhydramine, platifillin. These substances block potassium-sodium channels, which contribute to the transmission of nerve impulses along the nerve. Also, using electrophoresis, you can introduce B vitamins, which will improve the nutrition of the nerve and damaged myelin sheath.	It is better to alternate these procedures with other methods of physiotherapy every other day, 10 procedures in total.
Diadynamic currents	analgesic effect, decrease in pain intensity in subsequent paroxysmal attacks, prolongation of periods of remission.	For this method, Bernard currents are used, which are electric currents with an impulse of 50 thousand hertz. The electrodes are placed on the trigeminal nerve trigger zones, including the nasal mucosa. Bernard's current lowers the threshold of pain sensitivity, blocks the branches of the trigeminal nerve, thereby reducing the intensity of the pain syndrome, until it stops completely. The use of diadynamic currents in combination with electrophoresis and other methods of physiotherapy is effective.	Several courses for 5 days with a break of 5-7 days, the procedure lasts for 1 minute.
Massage	Prevention and treatment of atrophy of mimic and masticatory muscles.	Massaging the muscles of the face, head and neck improves blood circulation and lymph flow, thereby improving their nutrition. Massage is carried out carefully, it should not affect trigger zones and provoke the development of pain attacks. Stroking, rubbing, vibration movements are used. A course of massage is prescribed only against the background of a stable remission of the disease.	10 sessions.
Acupuncture (acupuncture)	Removal of pain syndrome.	Acupuncture affects nerve receptors that transmit impulses to nerve fibers. In this case, several points are selected in the trigger zones and several points are remotely on the opposite side. Sometimes the needles are set for a long period - a day or more, periodically scrolling them.	The duration of treatment is selected individually, often only a few procedures are enough.

All physiotherapeutic methods of treatment should be used in combination with drug therapy and the elimination of factors that led to the development of the disease, since physical procedures are powerless as monotherapy (mono-one).

Prevention of trigeminal neuralgia

Timely application for medical care for the treatment of acute and chronic diseases of the ENT organs, timely sanitation of the oral cavity, and so on.
Annual preventive medical examinations in order to identify diseases of internal organs, endocrine glands, nervous and cardiovascular pathology.
Avoid injury to the face and head.
Avoid drafts and other types of hypothermia.
Blood pressure control and treatment hypertension, vegetative-vascular dystonia, atherosclerosis and other vascular diseases.
healthy image life:
- complete physical activity
- proper sleep and rest,
- adequate response to stressful situations,
- proper healthy nutrition containing a sufficient amount of vitamins, trace elements, unsaturated fatty acids and amino acids.
- hardening,
- smoking cessation, drug and alcohol abuse, etc.
Can't self-medicate pain in the face, remember that any manipulation can aggravate the course of trigeminal neuralgia.

Be healthy!