Let me show you a different kind of "toothache" - trigeminal neuralgia

Author: Fang Yanbo, The First Affiliated Hospital of Zhengzhou University

Reviewer: Luo Zhiyi, deputy chief physician, First Affiliated Hospital of Zhengzhou University

People often use a common saying "toothache is not a disease, but it hurts like hell" to describe the severity of toothache. Did you know that there is another kind of pain - trigeminal neuralgia, which is much more painful than toothache and is known as "the most painful pain in the world". Although this pain is not fatal, it is very stubborn and will occur frequently, causing great harm and pain to the patient's physical and mental health, and seriously affecting the patient's quality of life.

Figure 1 Copyright image, no permission to reprint

1.What is trigeminal neuralgia?

Trigeminal neuralgia is usually characterized by repeated episodes of short and severe pain like electric shock in the distribution area of ​​the trigeminal nerve in the face. It is mainly manifested by repeated attacks of unilateral facial pain, which lasts from a fraction of a second to 2 minutes, accompanied by electric shock-like intensity pain, such as shooting, stabbing or sharp stinging, and is caused by harmless stimuli. Some patients often chew continuously during an attack, which may induce reflex spasms of the facial muscles on the same side, called painful spasms. In some particularly sensitive facial areas, such as the lips, the side edges of the tongue, and the outside of the nose, touching these points can easily trigger pain, which is called trigger points or trigger points. Even talking, eating, washing your face, brushing your teeth or blowing the wind may induce pain attacks, so people often mistakenly think it is toothache and go to the dentistry department for treatment.

2.Who is most likely to suffer from trigeminal neuralgia?

It is more common in middle-aged and elderly people, with the peak age of onset being 40 to 50 years old. Women are more likely to suffer from the disease than men, including patients with hypertension, diabetes, hyperlipidemia, vascular sclerosis and multiple sclerosis.

3.What are the types of trigeminal neuralgia?

It is divided into 3 categories based on etiology: classic, secondary, or idiopathic.

(1) Classic type: This is the most common type, accounting for 75% of cases. When morphological changes such as compression of the trigeminal nerve and blood vessels accompanied by ipsilateral pain occur, the classic type is diagnosed. Magnetic resonance angiography can be performed to show the relationship between the trigeminal nerve and the surrounding blood vessels.

(2) Secondary: accounting for approximately 15% of cases, caused by identifiable underlying neurological diseases (except trigeminal nerve vascular compression), such as cerebellopontine angle tumors, arteriovenous malformations, and multiple sclerosis.

(3) Idiopathic: accounts for about 10% of cases and is diagnosed when there is no obvious cause of trigeminal neuralgia.

4. How to treat trigeminal neuralgia?

Treatment principles include causal treatment and symptomatic treatment.

(1) If the disease is caused by other diseases, the primary disease should be treated actively and the cause should be treated accordingly.

(2) The treatment of classic and idiopathic trigeminal neuralgia aims to relieve pain symptomatically. Drug treatment is the first choice and is suitable for first-time patients, elderly patients, and those who are not suitable for or unwilling to undergo surgery. Commonly used drugs include carbamazepine, oxcarbazepine, pregabalin, gabapentin, baclofen, etc. Surgical intervention measures are only suitable for patients who are ineffective or cannot fully tolerate drug treatment. In drug-resistant cases, trigeminal nerve microvascular decompression is the first-line surgery for patients with classic trigeminal neuralgia, while nerve ablation surgery and microvascular decompression can be considered for idiopathic trigeminal neuralgia.

Figure 2 Copyright image, no permission to reprint

5.How to prevent trigeminal neuralgia?

Preventive measures for trigeminal neuralgia:

(1) Take medicine on time and as directed by your doctor to avoid the "rebound" phenomenon.

(2) Reduce stimulation. Eating, brushing teeth, and other actions should be done gently to avoid stimulating the "trigger point".

(3) Eat a light diet. Eat light, easy-to-chew food and avoid irritating and cold foods.

(4) Take regular rest and maintain a regular schedule, avoid fatigue, maintain a quiet environment and get enough sleep.

(5) Be cheerful: Maintain a good mental state and emotional stability, and avoid mental stimulation.

(6) Keep your head and face warm and avoid excessive cold or heat.

Figure 3 Copyright image, no permission to reprint