Trigeminal Neuralgia
The sensory roots of the trigeminal nerve radiate nearly all over the human face and are responsible for the sensational feelings of the face.
Most of the time pain attacks which are caused by a trigeminal neuralgia can be electrical, cause sharp and strong pain and appear suddenly.
The pain attack can be triggered by air drafts, food, brushing the teeth or simple washing of the face with cold water.
In most of the cases a trigeminal neuralgia is caused by a too tight connection between the nerve and certain arteries in the region of the brain stem.
Diagnostic criteria by IHS
A: Paroxysmal attacks of pain lasting from a fraction of a second to 2 minutes, affecting one or more divisions of the trigeminal nerve and fulfilling criteria B and C
B: Pain has at least one of the following characteristics:
- intense, sharp, superficial or stabbing
- precipitated from trigger areas or by trigger
C: Attacks are stereotyped in the individual patientiet
D: There is no clinically evident neurological deficit
E: Not attributed to another disorder
Anyways it is necessary to organize a magnetic resonance imaging. Sometimes it is possible to recognize a too close association between the nerve and a certain artery which can be the cause for e trigeminal neuralgia. Other possible diseases like a tumor or multiple sclerosis can be excluded directly.
Basis-Diagnostic
Anamnesis (duration, used drugs, social anamnesis)
Examination (clinical report of the cranial nerves, cervical spine, teeth- condition, blood pressure)
Characterization of headache (throbbing, electrical, sharp)
Localisation (occipital, bilateral, unilateral, frontal)
Temporary appearance (how often?, how long lasting?)
Trigger (menstruation, wine, cheese, sleep, sport, sex)
Headache questionary by Essen
Calender for headache
Excluding of other diagnosis (blood pressure, MRT of the head, blood sample)
typical trigeminal neuralgia
The trigeminal neuralgia gets triggered by a vessel in the brain which pushes on the trigeminal nerve. The most important fact which contributes to a trigeminal neuralgia is the eldering of the vessels.
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atypical trigeminal neuralgia
Gamma knife
Gamma Knife Bestrahlung
The treatment with drugs can help to alleviate pain.
Radiotherapy:
During a radiotherapy the patient needs to come for one meeting where the sensory pain fibers get desolate them.
Operation by Janetta:
This is a microsurgical procedure where the surgeon relocates the vessel which pushes on the facial nerve. Nearly 90 % of all typical trigeminal neuralgias can be treated with this procedure.