Trigeminal neuralgia - devastating, yet easy to treat disease

What is the trigeminal nerve?
Typical trigeminal neuralgia is a disease affecting trigeminal nerve. The trigeminal nerve is a cranial nerve that provides the face with the sense of – touch, temperature and pain. The third branch of this nerve also provides motor function to the muscles of mastication. There are two trigeminal nerves serving the corresponding side of the face where they are located.

As the name of the nerve implies – it has three branches. The trigeminal nerve originates in the brain stem, at the base of the skull it divides into 3 branches that innervate the skin of the face. The first branch is responsible for sensation in the forehead and the region above the eye, the second branch is tasked with sensation in the upper jaw and the third branch deals with sensation in the lower jaw.
Typical trigeminal neuralgia is a disease that is characterised by typical presentation of pain in distribution of trigeminal nerve. Patients describe trigeminal nerve pain (aka tic doloureux) as a sudden, electrical shock affecting one side of the face in a specific area. The patient is usually able to accurately pinpoint the area affected by the pain. The pain is usually jolt-like, shooting, sharp and intolerable. Generally, the pain is intermittent, meaning that exacerbations, which tend to be more frequent in the autumn and spring season, are replaced by periods of remission when pain is minimal or at all absent. Such periods of remission may be several months long. It should be noted that the longer a person suffers from trigeminal neuralgia, the shorter and more unstable the painless periods become.

Pain can be spread through the innervation area of a singleor several nerve branches, sometimes all branches are affected at the same time (please see picture). Pain is most often localized to the second and third branches of the nerve. Trigeminal nerve pain can, quite often, mimic toothache. It is often observed that several healthy teeth are extracted before a correct diagnosis is established.

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