Early manifestations of trigeminal neuralgia

Written by Chen Yu Fei
Neurosurgery
Updated on September 24, 2024
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For patients with trigeminal neuralgia, the initial symptoms mainly include sudden onset of intense pain that stops abruptly. The nature of the pain is generally sharp, resembling sharp stabbing or knife-like pain. In most cases, trigger points are easily formed on the face, commonly appearing around the bilateral nostrils and corners of the mouth as fixed trigger points. Touching these trigger points can easily trigger an attack of trigeminal neuralgia, which lasts for a relatively short duration, typically from a few seconds to several seconds. In most cases, attacks are more likely to be triggered when the patient is tired, fatigued, or under mental stress.

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Written by Shu Zhi Qiang
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How is trigeminal neuralgia diagnosed?

Trigeminal neuralgia is divided into primary and secondary types. Primary trigeminal neuralgia refers to cases where no specific cause is apparent. However, with the advancement of modern medicine, doctors have discovered that there is actually a cause for primary trigeminal neuralgia. It is due to the lack of protective myelin sheath over the initial segment of the trigeminal nerve, which gets irritated by the pulsation of nearby small arteries. In such cases, further investigations like brain MRI and cerebral angiography can usually identify the responsible blood vessel. On the other hand, secondary trigeminal neuralgia occurs along with corresponding tumors and inflammation during the progression of the neuralgia, and MRI can assist in diagnosis.

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Neurosurgery
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Causes of Trigeminal Neuralgia

At present, there is no consensus on the specific causes of trigeminal neuralgia. Most scholars believe that the main cause of trigeminal neuralgia is still due to the presence of a local responsible blood vessel around the trigeminal nerve, which compresses the trigeminal nerve, leading to abnormal discharges of the trigeminal nerve. This results in sudden attacks and sudden stops of severe, knife-like or burning pain, also known as trigeminal neuralgia. In terms of treatment, it mainly involves active drug therapy and some physical therapies, such as massage, manipulation, physiotherapy, and acupuncture. Most patients who experience poor results from conservative treatments can opt for microvascular decompression surgery, which often achieves good therapeutic outcomes.

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Written by Jiang Fang Shuai
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Can trigeminal neuralgia be cured completely?

Trigeminal neuralgia manifests as stubborn, intractable pain, but that does not mean we are helpless against it. The treatment of trigeminal neuralgia mainly involves the following aspects. Medication can only relieve symptoms and is not a cure. Radiofrequency ablation can destroy the trigeminal ganglion, but there is also a high probability of recurrence. The principle of Gamma Knife is somewhat similar to radiofrequency ablation, and the possibility of recurrence is also relatively high. Currently, the most effective treatment for a complete cure is surgical treatment, with about 80%-90% of patients with trigeminal neuralgia achieving complete eradication through treatments such as microvascular decompression surgery.

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Trigeminal neuralgia symptoms display

Trigeminal neuralgia typically manifests as sudden, severe facial pain, most often occurring in areas such as the upper lip, nostril, or corner of the mouth. These areas are prone to forming trigger points, and touching or stimulating these points can provoke an episode of pain. Most often, pain attacks occur when the patient is talking or eating, causing sudden cessation of the activity. The patient may experience unilateral facial muscle spasms, and reactions such as frowning, clenching teeth, opening the mouth wide, covering the eyes, or vigorously rubbing the face with the palm of the hand, leading to rough, thickened skin and eyebrow hair loss.

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Is trigeminal neuralgia dangerous?

Trigeminal neuralgia manifests in the regions of the face covered by the distributions of the trigeminal nerve, featuring recurrent, severe pain. The onset of the disorder is sudden and it resolves quickly as well. The pain is usually described as cutting, electric shock-like, burning, or tearing; it is a stubborn, difficult-to-treat pain, colloquially known as the "king of pain" and "the foremost pain in the world," which reflects the extreme level of pain associated with trigeminal neuralgia. Trigeminal neuralgia is generally not fatal, but it inflicts significant harm on the human body, making sufferers feel as if death would be preferable. It causes substantial psychological and physical obstacles and can even trigger the onset of some cardiovascular and cerebrovascular diseases, potentially leading to sudden death. Thus, trigeminal neuralgia is considered a rather dangerous disease.