All people have experienced pain at least once in their lives unknown origin, but most often they go away on their own or can be easily stopped by taking painkillers from a home medicine cabinet. However, a situation may arise when the pain does not disappear, but only intensifies, forcing to seek help from a doctor. What is the reason for this pain?

What is neuralgia, types of disease

Neuralgia is a disease of the peripheral nervous system, which is manifested by the strongest pain syndrome, the pain is localized along the affected nerve. In severe cases, sensitivity and motor function may be impaired.

There are several classifications of neuralgia:

By etiology (origin):

• Primary (essential) - as a rule, the cause of such pain cannot be established;
• Secondary (symptomatic) - are not an independent disease, but just a symptom of others.

By localization:

• Extremities;
• Faces;
• Torso.

The most common types of neuralgia are:

• Trigeminal nerve;
• Intercostal nerves;
• External cutaneous nerve of the thigh;
• Winged knot;
• Glossopharyngeal nerve;
• Occipital nerve.

Trigeminal neuralgia

Trigeminal neuralgia (trigeminal neuralgia) is a chronic disease characterized by severe pain in the innervation of the trigeminal nerve. According to ICD - 10, it has the following code: G50.0, G44.847.

In order to understand where the pain is localized, it is necessary to study the topographic anatomy of the trigeminal nerve. The trigeminal nerve (n. Trigeminus) is the fifth pair of cranial nerves, it contains both sensory and motor nerve fibers, which means that it is responsible for the sensitivity of the skin and mucous membranes and for the activity of facial muscles. It emerges from the brain stem and is divided into three large branches (for which it got its name): the orbital, maxillary, and mandibular nerves.

The first branch (eye) leaves the cranial cavity through the supraorbital opening (or notch) and innervates the skin of the upper half of the face, the frontal and parietal regions, the mucous membranes of the ethmoid and frontal sinuses, and the meninges.

The second (maxillary) leaves the infraorbital opening in the canine fossa and innervates the skin of the face from the upper lip to the lower eyelid, the teeth of the upper jaw, the lining of the brain.

The third (mandibular) innervates the skin along the mandibular bone, the chewing muscles, the palate and the muscle that strains the eardrum.

This is not the entire list, because each of these branches, in its course, gives off a lot of small nerves. The localization of pain is determined by the affected nerve.

Pathogenesis of trigeminal neuralgia

When the etiological factor acts on the trigeminal nerve, it is damaged, which leads to the loss of the myelin sheath. In this case, the nerve is exposed and its sensitivity increases, in such a situation, any, even the smallest, irritation leads to pain.

Causes

The causes of damage to the trigeminal nerve can be very diverse and it is not always possible to establish them. The most common are:

• Compression of nerve trunks by nearby passing vessels (aneurysms);
• Compression of a nerve in the bone canal, due to edema or anatomical anomalies in the development of bones;
• Acute and chronic diseases of the nervous system (meningitis, herpes, multiple sclerosis, etc.);
• Mental disorders (stress, depression);
• Diseases of adjacent anatomical structures (sinuses, eye socket, teeth, etc.);
• Bruises, concussions, fractures of the bones of the skull;
• Hypothermia.

Establishing the cause of the disease is the key to successful treatment.

Symptoms

The most important symptom is pain. It is localized in the face and due to the large number of structures innervated by the trigeminal nerve, pain can be similar to diseases of other organs. This fact complicates the diagnosis.

Pain with trigeminal neuralgia can be of two types:

• Typical - it is characterized by cyclicality, pain arises gradually reaching its peak, and then also gradually decreases and disappears. The frequency of pain attacks is different for each patient (it can be once a day or every hour). It has a shooting character (resembles an electric shock);
• Atypical (atypical) - this form is much less common. With her, there is constant pain that captures half of the face. She is very difficult to treat.

The slightest irritants, such as touching, talking, cold wind, eating, and others, can cause the onset or intensification of an attack of pain.

Other symptoms include:

• Violation of the sensitivity of the skin area innervated by the affected nerve (decrease or increase);
• Involuntary muscle twitching (tics);
• Increased lacrimation and hypersalivation (salivation);
• Hyperemia of the skin;
• Sleep disturbance;
• Decreased mood and increased fatigue.

All symptoms in this disease are not very specific, however, in most cases, no difficulties arise in the diagnosis.

Diagnosis of trigeminal neuralgia or paroxysmal facial pain syndrome

Taking a history of the disease is very important in the diagnosis. The patient should tell in detail about the time of the onset of pain, its duration, localization, factors provoking it.

After a detailed interview, the doctor proceeds to the examination; it is necessary to assess the patient's neurological status. Special meaning paid to palpation of the exit points of the trigeminal nerve.

ATTENTION! Care should be taken when palpating the exit points of the trigeminal nerve, as this manipulation can cause severe pain to the patient!

To clarify the diagnosis and determine the causes of damage to the trigeminal nerve, use:

• Ultrasound procedure;
• X-ray;
• Computed tomography;
• Magnetic resonance imaging.

These studies allow assessing the state of nearby anatomical structures, the patency of the bone canals and the state of the nerves themselves.

Treatment of trigeminal neuralgia

The main goal of treatment is to eliminate pain. If the etiological factor is known, then therapy is aimed at eliminating it, since this is the most effective method of treatment. In the case when the cause remains unknown, symptomatic treatment is performed.

Which doctor should I go to?

The first step is to go to a neurologist, if possible, because this disease refers to neurological pathologies. If there is no neurologist at the patient's place of residence, you need to contact a therapist.

Trigeminal neuralgia is usually treated by a neurologist. However, if the cause of the disease is the pathology of other organs or systems, then the treatment is carried out in conjunction with the appropriate specialists (ENT, maxillofacial surgeon, etc.).

Medication

Main groups medicinesused in the treatment of neuralgia:

• Anticonvulsants (Carbamazepine - the dose is selected individually);
• Antispasmodics;
• Muscle relaxants;
• Antibiotics (in cases of infection).

Physiotherapy procedures

This method is not used independently, only in combination with drug therapy. The most effective are:

• Electrophoresis with novocaine;
• Laser therapy;
• Diadynamic currents;
• Ultraphonophoresis;
• Acupuncture;
• Physiotherapy;
• Massage.

Surgical treatment of trigeminal neuralgia

The operation is resorted to in cases where conservative therapy has no effect or to eliminate the cause of nerve compression. The following operations are carried out:

• Decompression of the nerve (removal of a tumor, aneurysm, etc.);
• Stereotactic rhizotomy - percutaneous destruction of the trigeminal nerve root using an electric current;
• Balloon compression - compression of a nerve with a special balloon;
• Nerve destruction with glycerin injections;
• Radiofrequency ablation - the destruction of a nerve by temperature exposure;
• Ionizing radiation from a nerve.

Folk remedies for home use

IN folk medicine there is also a whole arsenal for the treatment of neuralgia:

• Black radish juice (rub into sore spots, helps relieve pain);
• Fir oil (has the same effect as the previous one);
• Clay (mix in vinegar and apply to the affected area);
• Tinctures: from hop cones, marshmallow root, duckweed;
• Garlic oil.

In some cases, they can relieve pain, but you do not need to get carried away with these methods, since they do not lead to a cure, but only reduce the symptoms.

Pregnancy treatment

The most effective group of drugs (anticonvulsants) for this pathology is contraindicated in pregnancy. This is because these drugs cause a deficiency of folic acid in the mother's body, which can interfere with the normal development of the fetus. This group is absolutely contraindicated in the first trimester and can be prescribed under strict control of folic acid content in the next two.

Other treatments during pregnancy include:

• Vitamin therapy (group of B vitamins);
• Physiotherapy (electrical stimulation, acupuncture);
• Alcoholic nerve blockade;
• Surgical treatment (in case of failure of other methods).

Treatment of inflammation in children

For the treatment of this pathology in children, the same drugs are used as in adults. A feature is that the dosages are calculated based on the child's body weight. Before prescribing the drug, the doctor should take into account all possible side effects and choose another method of treatment in cases of high risk of their occurrence.

Forecast and prevention of trigeminal neuralgia

In most cases, the prognosis is favorable, with early diagnosis and good treatment, the pain disappears and a cure can be achieved. However, in the case of prolonged pinching of the nerve by a tumor or a swollen vessel, its ischemia in the flesh may occur until death. In this case, the pain disappears, but it will no longer be possible to restore the function of the nerve.

To prevent relapse, it is necessary to carry out prevention:

• Avoid stressful situations;
• Temper;
• Live a healthy life;
• Avoid hypothermia;
• Treatment of concomitant diseases.

Trigeminal neuralgia is a serious disease, as it not only causes pain, but can also cause serious disturbances in the sensitivity and movement of facial muscles. But, with timely seeking help, you can avoid these complications and effectively get rid of excruciating pain.

Trigeminal neuralgia Good day!
I am 16 years old
For about a week, pains in the right side of the face excruciate, as if all the teeth and gums hurt at once ...
I do not know the reasons for this ...
Previously, the attacks lasted 5 minutes once a day, I thought wisdom teeth were growing, but it was not there ...
For the last 2 days I have been suffering, crying from pain, my parents refer to the same teeth and think that everything will pass ...
I went to the dentist at night with hellish pain, but he yelled and sprinkled lidocaine on my teeth.
Can this be cured with pills? I want to shoot myself in pain
Conventional pain relievers don't work, sedatives don't.

Answer: Most likely we are talking about trigeminal neuralgia, in this case you need to contact a neurologist who can prescribe adequate treatment. In our clinic, this pathology is treated with acupuncture and classical homeopathy, which also gives a good and quick effect.

Best regards, K.L.Sager

Neurology in a child Good evening. My 11 year old daughter was diagnosed with 2 branch trigeminal neuralgia. It hurts in the ear, under it, but the main thing is the mind shell itself, the cartilage. Antibiotics, nise, diclofinac, finlepsin did not help. Everything is useless. ENT, the maxillary surgeon examined - all without pathology. The child is suffering. I see that neurologists are also at a loss. The drugs make her sick, she walks all pale. Please help with advice.

Answer: This problem is quickly solved by acupuncture, especially in childhood.

Best regards, K.L.Sager

Trigeminal neuralgia Hello. I don’t already know who to contact with my problem. Since August there have been severe pressing pains on the cheekbones. Then the jaw began to hurt on the sides on both sides, the burning sensation was very strong. After that, the face near the nose on the right side and the gums began to hurt. All this provoked pain in the toothache in the four. Numb near the mouth, also on the right side. The pain was constant, it could ache for a week, no changes, there was no pain at night. Then the left side began to hurt with the same symptoms. If the left side hurts, then the right one usually did not hurt and the same with the right side. The pain is just as aching, it intensifies, then it hurts less. I did an MRI of the head, blood vessels, everything is normal, there is cervical osteochondrosis, protrusions. All this time I drank pregabalin, carbamazepine, sirdalud, milgammu pricked, various anti-inflammatory. Nothing helps, Until now the pains have not stopped, the right and left sides also hurt, without asking. But these constant aching pains are already exhausting. Please advise me what to do.

Answer: You can contact the Scientific Center of Neurology https://www.neurology.ru if you do not live in Moscow, then remote consultation is possible.

Best regards, K.L.Sager

Trigeminal neuralgia Hello. The problem is that for more than 10 years, aching pains in the area of \u200b\u200bthe lower teeth and chin bones, on the left side, have been plagued. A feeling of fullness, pain is transmitted from the bottom of the jaw bone to the teeth-lower incisors and a little to the molars. At first there were short pains, a week or two. Then they passed. With a frequency of 1 or 2 times a year. Now, as they began the year before last in the fall, they still do not pass. Visiting doctors (dentists, neurologists, neurosurgeons) does not give a positive result. Dentists experimentally removed nerves from two of the lower incisors. From one unsuccessful, I had to remove it. They also removed the second one, the problem did not go away. Two lower incisors have already been removed. The problem has not gone away, the pains remain and torment, constantly. No medicine works absolutely. These are all sorts of expensive non-steroidal PVS, Lyrica, Carbamazepine, Amitriptillin, Pentalgin, Nise, MIG, topical ointments with Lidocaine (Kamistad, Cholisal, Metrogyl Denta) Some antidepressants (Terralidzhen, Phenazepam). Neurologists do not find any pathology at all or do not want to see. Numerous X-ray photographs show nothing suspicious. Two months ago, I did an MRI scan of the brain and cerebral vessels using an apparatus in Gorno-Altaysk. No specific deviations were found. I was hospitalized three times in the neurosurgery department. Submandibular blocks were made, in the area of \u200b\u200bthe pterygoid fold and in the chin opening on the left. An incision was made on the left jaw. Alcohol was poured into the chin hole. The lower lip on the left died. The toothache only intensified. I live in the small town of Gorno-Altaysk, Altai Republic, Russia. I don't know what to do next. Life becomes unbearable. Financially limited - disability pensioner. Therefore, I do not have the opportunity to undergo treatment here or in another city. I would like to receive advice, consultation in advance in absentia. Perhaps your advice will help our doctors make the correct diagnosis and prescribe more or less effective treatment. Sincerely, Alexander

Answer: Unfortunately, it is impossible to remotely resolve such issues, especially in such a specialized aspect, it is best to contact the Scientific Center of Neurology, where telemedicine consultations are held https://www.neurology.ru/konsultacii/telemedicinskie-konsultacii

Best regards, K.L.Sager

The trigeminal nerve Hello, my father-in-law has lung cancer. After the 6th chemotherapy he started having severe headaches, and it turned out that the trigeminal nerve became inflamed. Are these the consequences of cancer? Is there any cure? An antibiotic is given to him, but there is no result of fate

Answer: Most likely, against the background of chemotherapy, there was a decrease in immunity, which could cause damage to the trigeminal nerve. Most often, the cause of this disease is the herpes virus, so antibiotics are not indicated in this case (if they were prescribed for this particular diagnosis), it is best to contact a neurologist who can prescribe adequate treatment.

Best regards, K.L.Sager

Trigeminal neurology How to treat severe sharp pains in vestiges where the eyebrow is on the left side.

Answer: This pathology is effectively treated with acupuncture and homeopathy,

Best regards, K.L.Sager

Neuralgia Hello! I have pain on the left side of my face. For several years now. I was diagnosed with inflammation of the trigeminal nerve. I took injections, pills. For a while, the pain seems to subside, the mouth starts again. It is impossible to eat, talk. Can there be another effective treatment? What folk remedies can be treated? What will help me best?

Answer: Acupuncture and classical homeopathy quite effectively help with this pathology, but given the age of the disease, treatment can take a long time.

Best regards, K.L.Sager

Neurology Good evening, I have such a problem, constant pressing headaches, my eyes hurt as if I was diving into a river with open ones, my head was spinning, while a constant feeling of fear, what could it be? lobes of the brain.Moreover, all symptoms were suppressed after instillation of painkillers and vasodilators in the hospital.

Answer: Perhaps we are talking about neurocirculatory dystonia, in which the appearance of this symptomatology is possible, in traditional medicine you need a consultation with a neurologist to clarify the diagnosis and clarify the nature of the formation in the temporal lobe of the brain.

Best regards, K.L.Sager

Neuralgia of the facial nerve (diagnosed by a neurologist) Hello dear doctor! I am a medical worker (I work at the SES). 3 weeks ago, I woke up at 3 am with severe pain on my face on the left side. At the same time, I slept wide open with an open balcony. In addition, I worked hard all November (three of my employees were on the courses), so a big load fell on me. Tell me, could this have caused neuralgia? I tried to apply a boiled egg, which provoked a new attack. But reference books write about this proven method of treatment. The neuropathologist prescribed nimid, serox and carbamazepine. The attacks have become less frequent, but today my legs are frozen during the heavy cold rain, and now in the evening 2 attacks. I'm suffering. What do you advise?

Answer: In our clinic, this pathology is effectively treated with acupuncture and classical homeopathy, and the sooner the treatment is started, the faster the pain syndrome is relieved.

Best regards, K.L.Sager

Trigeminal neurology I can't get an appointment with a good neurologist. My problem is that from time to time I have pain in the nasolabial part of the face in the form of numbness and painful touch, pain in the ear, cheek, jaw, neck, on the right side of the head, pain in the front of the neck muscle and painful to swallow. And all this arises when the pressure rises, which is difficult to bring down, I suffer from cervical chondrosis, MRI showed the growth of the lesion. I cure myself, Kolya relaxing and anti-inflammatory drugs. Questions, call, can this disease provoke a stroke? I am 66 years old, pain syndrome began to show itself in the spring of this year

Answer: Unfortunately, in this case it is impossible to make any prediction. An additional examination is needed, a consultation with a neurologist to clarify the diagnosis, only after that it will be possible to prescribe treatment and talk about prospects for the future.

Best regards, K.L.Sager

Scientists call this disease Trousseau's tic pain and Fosergil's disease and is known to patients as trigeminal neuralgia. It is possible to independently determine the pathology by paroxysmal, extremely intense pain in the area of \u200b\u200bthe eyes, forehead, jaw. If you find this distinctive feature, you should immediately contact a medical institution, even a single symptom that has arisen is a reason to start treatment of trigeminal neuralgia as soon as possible.

Anatomical structure

The fifth pair of cranial nerves is called the trigeminal nerves, they are located symmetrically: on the right and left sides of the face. The function of the trigeminal nerve is the innervation of a number of facial muscles.It consists of three main branches, including many smaller branches. The path of the branches to the innervated areas passes through channels in the bones of the skull, where nerve fibers can be compressed.

Causes of trigeminal neuralgia

Revealing the origin of neuralgia allows you to objectively assess the clinical picture and cure the patient quickly and with minimal stress on the body. The most common causes of trigeminal neuralgia are considered by doctors to be:

• vascular pathologies, including changes and abnormalities in the development of blood vessels or their location;
• deterioration of blood flow due to hypothermia of the face area;
• inflammatory processes in the branching zone, which can be caused by otorhinolaryngological, eye and dental problems;
• trauma to the face and skull;
• violation of metabolic processes in the body;
• chronic viral diseases;
• congenital narrowness of the canals along the branches;
• any tumors localized to the trigeminal nerve zone;
• multiple sclerosis;
• allergic inflammation;
• stem stroke;
• psychogenic factors.

Risk group and features of the course of the disease

Trigeminal neuralgia is a very common reason for visiting a neurologist. This is due to the large number of factors provoking the development of the disease, painful attacks of extremely high intensity and long-term therapy of neglected cases. The number of people at risk for trigeminal neuralgia is quite large.

Middle-aged people are more susceptible to neuritis, mainly the disease manifests itself between the ages of 40 and 50. The percentage of patients with trigeminal neuralgia among women is significantly higher than among the male part. An important determining factor is the presence of chronic diseases contributing to the development of neuralgia in the patient's history.

In seventy percent of cases, the right side is affected, both sides are rarely affected by the disease. The course of the pathology is cyclical: the acute period is replaced by remission. Peaks of exacerbations occur in autumn and spring.

Symptoms of facial trigeminal neuralgia

Fosergil's disease has clear symptoms that are obvious even to a layman. However, how to effectively treat trigeminal neuralgia can only be determined by a doctor who takes into account the entire clinical picture.

Symptoms of Trousseau's pain tic are divided into three groups, which manifest themselves in stages: at first, only pain is disturbed, then motor and reflex, and then vegetative-trophic disorders. At the third stage, not only the symptomatology undergoes changes, but also the medical prognosis for complete healing significantly worsens.

The nature of the pain

The first sign of Trousseau's pain tic is intense pain attacks in the innervation zone of the affected branch. The pain is burning and excruciating, characterized by extreme intensity, it is paroxysmal, arises very sharply.

Patients compare a painful attack with neuralgia with a lumbago and the passage of an electric current. Paroxysm lasts from several seconds to several minutes. At the time of exacerbation, the frequency of attacks is very high.

According to a scientific article devoted to the study of the disease, a painful attack with neuralgia can occur up to three hundred times per day.

Localization of pain

Pain can be localized both in the innervation zone of the entire nerve, and in one of its branches. A characteristic feature is that the pain spreads from one branch to another, and over time, the entire affected half of the face is involved. The longer the illness lasts without medical intervention, the more likely it becomes to damage the entire nerve and the spread of the pathological process to other branches.

With lesions of the eye branch, the pain is concentrated in the forehead and eye. With a disease of the maxillary branch, the pain spreads to the upper and middle part of the face. Lesions of the mandibular nerve can provoke the onset of pain in the area of \u200b\u200bthe masticatory muscles, the lower jaw and the wings of the nose. Sometimes echoes of pain are felt in the neck, temple, and occiput.

It happens that the pain is clearly concentrated in the area of \u200b\u200ba particular tooth, which is why the dentist often becomes the first specialist to see a patient with neuralgia. When examining the tooth, the cause of the pain is not revealed, but if the treatment is still carried out, this does not bring any effect or relief. The main task of a dentist in such a situation is to refer the patient to a consultation with a neurologist.

Pain provocation

Painful paroxysm can be triggered by touching or pressing on the exit points of nerve branches in the face and trigger zones. Everyday activities, such as chewing and brushing teeth, washing, shaving, even a breath of wind, speaking and laughing, can also cause an attack of pain. At the moment when an attack occurs, the patient often freezes, afraid to make the slightest movement, and lightly rubs the pain zone.

Movement and reflex disorders

• Facial muscle spasm. At the moment of paroxysm, the muscles of the face contract involuntarily. Reflex disorders begin with blepharospasm or trismus, with the course of the disease, spasms can be transmitted to the entire half of the face.
• Degradation of the supraorbital, corneal and mandibular reflexes. Disorder is revealed when examined by a neurologist.

Vegetative trophic symptoms

At the initial stage of the disease, vegetative-trophic symptoms are practically absent, or symptoms appear exclusively during an attack. Only the occurrence of painful paroxysm, local redness or pallor of the skin is characteristic. The secretion of the glands changes, a runny nose, lacrimation and salivation may appear.

With the progression of the disease, the vegetative-trophic symptoms of trigeminal neuralgia also increase, and therefore treatment requires a longer and more extensive one.

Symptoms of an advanced case of neuralgia

In advanced cases, a number of symptoms are added. Elimination of the cause of the disease leads to recovery in more than a hundred percent of cases, complex methods of treatment are required.

Signs of advanced trigeminal neuralgia are:

• Swelling of the face, loss of eyelashes, change in the secretion of the skin glands.
• Spread of pain to other parts of the face.
• The appearance of pain from the slightest pressure on any part of the face from the affected side.
• The onset of pain to any stimulus, up to a loud sound or bright light, may even be a reminder of a previous attack.
• Permanent nature of pain.
• Change in the localization and duration of pain attacks.
• Strengthening vegetative-trophic symptoms.

Diagnostics

Correct treatment of trigeminal neuralgia requires the identification of all symptoms, they will help determine the stage and specifics of the course of the disease. Anamnesis and questioning of the patient are of paramount importance in making a diagnosis. Examination helps to determine the localization of a decrease and increase in skin sensitivity on the face, to identify possible degradation of muscle reflexes.

During the period of remission of the disease, if it is at an early stage, the pathology is not always noticeable on examination. To detect the cause of neuritis, an MRI scan may be recommended to the patient, however, even the most modern tomography performed in Moscow does not always show pathology. Patients with symptoms of neuralgia are advised to see a neurologist immediately.

Fosergil's disease treatment methods

Treatment of trigeminal neuralgia is performed by the following methods, mainly used in combination:

• physiotherapy;
• prescribing drugs;
• surgical intervention.

Attempts to cure all kinds of folk remedies are not only ineffective for neuralgia, but also very dangerous. The main risk is that time will be lost and qualified assistance will not be provided on time.

Treatment with medications

Prescription of drug treatment is justified when the cause of trigeminal neuralgia is vascular pathology or a tumor. The therapy involves:

• Antiepileptic drugs.
• Pain relievers or injections.
• Muscle relaxants.
• Antiviral agents.

The main drug in most cases is an anticonvulsant drug based on carbamazepine. Vitamin-based adjuvant therapy has proven itself well. In addition, they are used for treatment.

• Valproic acid.
• Pregabalin.
• Baclofen.
• Gabapentin.
• Lamotrigine.

The doctor selects the optimal drugs and dosages individually. The main tasks of therapy are to relieve pain attacks, eliminate the causes of the disease, and prevent complications. Treatment of trigeminal neuralgia with medications takes about six months with a gradual decrease in medicinal doses.

Surgery

It is better to carry out the operation in the early stages of the disease, this increases the likelihood of complete healing.Today, two main groups of operations are used to treat neuralgia. One is effective in cases where it is necessary to correct the position of the artery, or if neuralgia is provoked by compression of the nerve branch by some anatomical formation. The second is used if neuralgia was treated with conservative methods, and the therapy did not give positive results.

The type of surgical intervention differs depending on the pathology that caused the neuralgia:

• If the cause of the compression is vascular pathology, microvascular decompression is used. This is a microsurgical operation during which a nerve and a vessel are separated. The effectiveness of the method is very high, but it must be taken into account that the operation is traumatic.
• If the reason is the development of a tumor process, the tumor is removed first, and after that treatment is prescribed.
• If it is necessary to remove painful impulses along the nerve fiber, percutaneous balloon compression is performed.

In some cases, nerve destruction is necessary. For this, the following methods are used:

• Non-invasive ionizing radiation. Used only in the early stages of the disease.
• Stereotactic percutaneous rhizotomy. The nerve root is destroyed under the influence of an electric current, which is supplied to the damaged area using the thinnest electrode.
• Radiofrequency ablation, in which nerve fibers are destroyed by heat.
• Glycerin injections at the nerve branching sites.

Physiotherapy treatment

For the speedy relief of pain symptoms and complete healing, physiotherapy procedures are prescribed in tandem with drug therapy. After the start of treatment, surgical or physiotherapy, the pain does not immediately disappear. The period for the complete disappearance of paroxysm is individual and is due to the vastness of the process, the duration of the disease, therefore, in addition, the doctor prescribes pain relievers.

The greatest efficiency in the treatment of Trusso's pain tic is shown by the following procedures:

• laser therapy;
• diadynamic currents;
• electrophoresis using novocaine;
• acupuncture;
• phonophoresis with hydrocortisone.

Preventive measures

It is impossible to avoid all potentially dangerous factors, especially considering that some of the reasons are congenital: narrowness of the canals, pathology in the structure and location of blood vessels. However, you can reduce the risk of the disease by eliminating several provoking factors. The primary prevention is:

• avoid hypothermia of the face and head;
• timely treat diseases that can give rise to trigeminal neuralgia;
• avoid head injuries.

Doctors consider the only timely treatment of diseases of the trigeminal nerve to be a full-fledged secondary prevention, therefore, at the first symptoms of pathology, you should immediately contact the clinic.

Possible complications

It is impossible to start trigeminal neuralgia, fosergil's disease causes complications:

• paresis of the facial muscles;
• hearing loss;
• irreversible damage to the nervous system, up to inflammation in the brain.

It is absolutely impossible to relieve pain with analgesics and hopes that neuralgia will go away by itself. This is a serious neuralgic disorder that only a doctor should treat. The sooner the patient seeks help, the more successful and shorter the therapy will be.

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

Trigeminal neuralgia does not go away painlessly, it is a rather serious ailment. This disease most often affects women aged 50-70. In some cases, even surgery is required.

What is neuralgia, types of disease

The trigeminal nerve originates from the trunk of the anterior part of the pons varoli, located next to the middle legs of the cerebellum. It is formed from two roots - a large feeling and a small motor. Both roots from the base are directed to the apex of the temporal bone.

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

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

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

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

If one of the branches of the trigeminal nerve is affected, a variety of disorders can appear. For example, an area of \u200b\u200binnervation may become insensitive. Sometimes, on the contrary, it becomes too sensitive, almost to a painful state. Often, part of the face sags, as it were, or becomes less mobile.

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

1. Primary (true) neuralgia is considered a separate pathology arising from compression of a nerve or a violation of blood supply in this area.
2. Secondary neuralgia - the result of other pathologies. These include neoplastic processes, severe infectious diseases.

Causes

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

The reasons for the development of trigeminal neuralgia are very different:

• compression of the nerve in the area of \u200b\u200bits exit from the cranial cavity through the bony canal with an abnormal location of the cerebral vessels;
• aneurysm of the vessel in the cranial cavity;
• metabolic disease: , diabetes, and other endocrine pathologies;
• hypothermia of the face;
• chronic infectious diseases in the facial area (chronic, dental caries);
• metabolic disorders (diabetes mellitus, gout);
• chronic infectious diseases (tuberculosis, syphilis, herpes);
• mental disorders;
• suppuration of the bones of the skull, especially the jaws (osteomyelitis);
• severe allergic diseases;
• (worms);
• multiple sclerosis;
• brain tumors.

Symptoms of trigeminal neuralgia

The disease is more typical for middle-aged people, more often diagnosed in 40-50 years. The female sex suffers more often than the male. Damage to the right trigeminal nerve is more common (70% of all cases of the disease). Very rarely, trigeminal neuralgia can be bilateral. The disease is cyclical, that is, periods of exacerbation are replaced by periods of remission. Exacerbations are more typical for the autumn-spring period.

So, the typical signs of pain syndrome with trigeminal neuralgia:

• the nature of the pain in the face is shooting, extremely hard; patients often compare it with an electrical discharge
• duration of an attack of neuralgia - 10-15 seconds (no more than two minutes)
• the presence of a refractory period (the interval between attacks)
• localization of pain - does not change over several years
• pain of a certain direction (from one part of the face to another)
• the presence of trigger zones (areas of the face or mouth, irritation of which causes a typical paroxysm)
• presence of trigger factors (actions or conditions under which a painful attack occurs; for example, chewing, washing, talking)
• the characteristic behavior of the patient during an attack is the absence of crying, screaming and a minimum of movement.
• twitching of the masticatory or facial muscles at the peak of a painful attack.

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

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

Symptoms are difficult to interpret correctly if the patient's pain syndrome is insignificant.

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

Localization of pain

Pain attacks may not be isolated, but follow each other with a small interval. The pathogenesis of the development of trigeminal neuralgia is very diverse:

1. Usually, discomfort in any part of the face manifests itself in the form of an attack.
2. The pain fetters a person for a couple of minutes and temporarily recedes. Then comes again. Between painful attacks takes from 5 minutes to an hour.
3. The defeat resembles an electric shock. Discomfort is usually localized in one part of the face, but often the patient feels pain in several places at once.
4. It seems to a person that the pain covers the entire head, eyes, ears, nose. Talking during an attack is very difficult.
5. From the pain that constricts the mouth, it is extremely difficult to pronounce words. In this case, muscles can twitch strongly.

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

In occipital neuralgia, pain is usually located in the front and back of the head and can sometimes spread to the face.

What is the most common cause of trigeminal neuralgia pain?

In the event that a patient has neuralgia, then each attack occurs due to irritation of the trigeminal nerve, due to the existence of trigger, or "trigger" zones. They are localized on the face: in the corners of the nose, eyes, nasolabial folds. When irritated, sometimes extremely weak, they can begin to "generate" a sustained, prolonged painful impulse.

Pain factors can be:

1. shaving procedure for men. Therefore, the appearance of a patient with a shaggy beard can lead an experienced physician to "experienced neuralgia";
2. just lightly stroking your face. Such patients protect their face very carefully, do not use a handkerchief or napkin.
3. the process of eating, the procedure for brushing teeth. Movement of the muscles of the mouth, buccal muscles and pharyngeal constrictors provoke pain, as the skin of the face begins to shift;
4. fluid intake process. One of the painful conditions, since the quenching of thirst is punished with severe pain;
5. usual smile, as well as crying and laughter, conversation;
6. applying makeup on the face;
7. feeling of sharp odors, which are called "trigeminal" - acetone, ammonia.

The consequences of neuralgia for humans

Neuralgia of the trigeminal nerve in a neglected state entails certain consequences:

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

The risk group is made up of people of the older age category (more often women), people suffering from cardio vascular diseases or with impaired metabolism.

Diagnostics

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

Typically, the diagnosis of trigeminal neuralgia is made on the basis of the patient's complaints and examination. In the diagnosis of the cause of neuralgia, magnetic resonance imaging is important. It allows you to identify a tumor or signs of multiple sclerosis.

Basic diagnostic methods:

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

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

Treatment of trigeminal neuralgia

It is extremely difficult to cure this disease and not always even radical methods of treatment give a positive result. But the right therapy can relieve pain and significantly alleviate a person's suffering.

The main methods of treatment for trigeminal neuralgia include:

• medication;
• physiotherapy;
• surgical treatment.

Medication

IN drug treatment various groups of medicines are used, including such as:

• Anticonvulsants
• Antispasmodics and muscle relaxants.

Before using any drug, it is necessary to consult a neurologist.

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

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

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

Other drugs for trigeminal neuralgia:

• Gabapentin;
• Baclofen;
• Valproic acid;
• Lamotrigine;
• Pregabalin.

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

Physiotherapy procedures

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

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

Surgical treatment of trigeminal neuralgia

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

Surgical treatments for trigeminal neuralgia are often minimally invasive. In addition, the so-called surgical method also applies. radiosurgery is a bloodless intervention requiring neither incisions nor stitches.

There are the following types of operations:

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

The type of operation is prescribed depending on the individual characteristics of the course of the disease in the patient.

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

Folk remedies for home use

How to treat neuralgia with folk remedies? Using folk remedies it is important to remember that only symptoms are removed in this way. Of course, first of all, one should use folk recipeswhich can effectively help fight inflammation.

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

Folk remedies for the treatment of neuralgia at home:

1. Birch juice. Taking it orally or lubricating it with the side of the face affected by neuralgia, it is possible to reduce the symptoms of the disease. You need to drink this juice 4-5 glasses a day.
2. Beets are rubbed on a coarse grater. A small envelope is made of the bandage (the bandage is folded in several layers), into which the grated beets are put. Such a bundle is injected into the ear canal from the side where the inflammation appeared.
3. Black radish juice will also help. It can be mixed with lavender tincture or lavender essential oil and rubbed into the affected area. Then you should wrap yourself in a scarf and lie down for half an hour. It is permissible to fumigate the room in which the patient is located during an attack. This requires a wormwood cigar. It is twisted from dry leaves of wormwood and set on fire. Fumigation should last no more than 7-10 minutes. Such manipulations must be performed within a week.
4. Heat a glass of buckwheat in a frying pan, pour the cereals into a cotton bag and apply to the affected area. The bag is removed when it has completely cooled down. This procedure is performed twice a day.
5. We treat trigeminal neuralgia with pharmacy chamomile - an excellent sedative for NTN. It can be used to make morning tea. You should put some warm drink in your mouth, but do not swallow, but keep it as long as possible.
6. Grate the horseradish root on a coarse grater, wrap the resulting gruel in a napkin and apply in the form of lotions to the affected area.
7. To relieve tension in the body and relieve neuralgic pains, hot baths are recommended with the addition of a decoction of young aspen bark.

Prevention

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

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

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

So, getting rid of trinity neuralgia is possible. It is only necessary to seek help from specialists in time and undergo an examination. The neuropathologist will immediately prescribe the necessary drugs to combat the disease. If such funds do not help in the fight against trigeminal neuralgia, they resort to the help of a neurosurgeon who solves the problem in an operative way.