Is trigeminal neuralgia severe?

Written by Jiang Fang Shuai
Neurosurgery
Updated on September 05, 2024
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Trigeminal neuralgia is often described by people as the "world's first pain," highlighting the severity of this condition. Patients usually experience excruciating pain in the areas of the head and face served by the trigeminal nerve during activities such as washing their face, brushing their teeth, eating, drinking, combing their hair, and even in a state of rest. The pain can feel like cutting, burning, tearing, or electric shocks, making it unbearable and extremely agonizing. Clinically, trigeminal neuralgia is characterized by a sudden onset, long duration of illness, and a very slow, or even impossible, recovery. Therefore, those suffering from trigeminal neuralgia often face tremendous physical and psychological challenges. It is a serious disease.

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What are the symptoms of trigeminal neuralgia?

The clinical symptoms of trigeminal neuralgia are mainly characterized by severe, paroxysmal pain in the area of the face distributed by the trigeminal nerve, typically affecting one side. The pain can affect one, two, or all three branches of the trigeminal nerve. The pain is episodic, resembling cutting, electric shocks, and is sudden in onset and cessation, making it unbearable for the patient. In some patients, actions such as eating, washing the face, or brushing teeth can trigger the pain. Most patients have trigger points, commonly located near the nostrils, corners of the mouth, or upper lip.

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Trigeminal neuralgia pain level

The World Health Organization classifies pain into five levels. Level zero is no pain. Level one is mild pain that does not require medication. Level two is moderate pain that requires medication. Level three is severe pain that necessitates medication. Level four involves severe and intense pain, often accompanied by changes in vital signs such as blood pressure, pulse, and respiration. Trigeminal neuralgia is a type of severe pain that occurs repeatedly in the trigeminal nerve area. It is recognized globally as one of the most painful diseases, often referred to as the "world's greatest pain" and "the cancer that does not kill." Patients often live in a state of feeling better off dead, which indicates the extreme level of pain associated with this disease. The pain level for this condition is classified as level four, the highest level.

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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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Does trigeminal neuralgia cause dizziness?

For patients with trigeminal neuralgia, they generally do not experience dizziness. Trigeminal neuralgia is mostly due to the presence of a significant culpable vessel around the trigeminal nerve, which continuously compresses the nerve, leading to abnormal discharges of the trigeminal nerve. This is manifested as severe headache pain in the area distributed by the roots of the trigeminal nerve, most often characterized by sharp, stabbing pain, resembling a knife cut or tearing, which is often unbearable for patients. As the condition progressively worsens, the frequency and occurrences of trigeminal neuralgia attacks also gradually increase, often causing extreme pain for the patients.

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What should I do if trigeminal neuralgia recurs?

After the recurrence of trigeminal neuralgia, oral medication can be considered as the initial treatment. If the effect of the medication is not clear, or the side effects are intolerable, then balloon compression or radiofrequency treatment can be considered. These two methods can be used repeatedly, but they also have a certain recurrence rate. If neither medication nor radiofrequency treatment achieves satisfactory results, then surgical treatment can be considered. Microvascular decompression surgery of the trigeminal nerve can be performed under a microscope, where the trigeminal nerve and the blood vessel compressing it are separated, which can fundamentally resolve trigeminal neuralgia. (Specific medications should be used under the guidance of a physician.)