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 Gao Yi Shen
Neurosurgery
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Trigeminal neuralgia prodrome

Trigeminal neuralgia does not have very obvious precursors. This is because trigeminal neuralgia often occurs suddenly, especially with the concept of trigger points. That is to say, once the trigger point is activated, it immediately induces pain without any warning signs. Trigger points vary from person to person, usually located primarily on the cheek. Patients who frequently suffer from trigeminal neuralgia often know these areas. Typically, the pain occurs during activities like brushing teeth with cold water or chewing hard foods such as peanuts or walnuts, triggering severe pain instantly. Thus, in the case of trigeminal neuralgia, there are no precursors, only immediate triggers and immediate pain.

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Written by Chen Yu Fei
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
Neurosurgery
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Is trigeminal neuralgia severe?

Trigeminal neuralgia is one of the most common, stubborn, and excruciatingly painful diseases, known by patients as the "world's most severe pain." The intensity of the pain during an episode can surpass even that of childbirth. When the pain is severe, patients dare not speak, eat, or sleep, causing immense suffering in their lives. In extreme cases, the unbearable pain leads to suicidal thoughts. Therefore, trigeminal neuralgia is also referred to as the "non-lethal cancer," a serious neurological disorder.

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Written by Jiang Fang Shuai
Neurosurgery
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trigeminal neuralgia area

The trigeminal nerve, being the fifth pair of cranial nerves, branches into three divisions after emerging from the skull. The first division is the ophthalmic division, which innervates the upper eyelid and superficial parts of the eye and forehead. The second division is the maxillary division, governing the cheek, upper lip, and gums. The third division is the mandibular division, which affects the lower lip and gums. Trigeminal neuralgia is pain that occurs in the areas innervated by the trigeminal nerve, typically affecting one side and primarily involving the second and third divisions, with the second being the most common and the third next, while the first division is rare. The pain of trigeminal neuralgia can be confined to the area of one division or can occur in two or all three divisions simultaneously.

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Written by Jiang Fang Shuai
Neurosurgery
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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.