what it is, causes, symptoms and treatments

Common gestures such as chewing, talking, eating, brushing your teeth or combing your hair can trigger stabbing pain in the face called trigeminal neuralgia.

He trigeminal It is the most important nerve that runs through our face. It has two very clear functions, on the one hand the motor function related to chewing, and on the other hand a sensory function, the most important. Therefore, when a patient suffers from neuralgia of this nerve, the pain can be unbearable.

On International Trigeminal Neuralgia Day, which is celebrated this Saturday, October 7, we spoke with the Dr. Pablo IrimiaCoordinator of Headache Study Group of the Spanish Society of Neurology:

• “Neuralgia is any acute pain that follows the path of a nerve. And the trigeminal is the main sensory nerve of the face, since its three branches cover the region of the eyecheek and jawso people who suffer from trigeminal neuralgia can experience pain in any part of their journey.

So we are talking about a type of facial or headache pain that differs from other headaches, “in addition to its intensity and its stabbing or electrical nature, because it is very common for it to be activated when carrying out daily activities such as chewing, to talk, to eat, brush your teeth or comb your hair.”

“Any tactile or thermal stimulus on the face, even if it is mild, can trigger a very disabling pain crisis.”

The most common facial pain

Trigeminal neuralgia is the most common type of facial pain in adults. According to data managed by the SEN, more than 35,000 Spaniards suffer from it.

Of them, 90%-95% of cases affect the second and third branches of the trigeminal nerve (maxillary and mandibular area respectively) and usually Only one side of the face is usually affected: Only in 2-5% of cases is the pain bilateral.

Although there are multiple factors that can be responsible for the appearance of this neuralgia, the most common thing is that it occurs due to vascular nerve compression(primary trigeminal neuralgia) although on other occasions its origin cannot be determined (idiopathic neuralgia).

This acute pain can also occur secondarily as a consequence of other pathologies (15% of cases of trigeminal neuralgia), such as the presence of a tumor, or suffering from multiple sclerosis.

• “When trigeminal neuralgia debuts in young people“, has a bilateral character, the first branch of the trigeminal nerve (ophthalmic) is affected and in addition to the crises there is continuous pain, most likely it is a secondary form.”
• “On the contrary, when the pain is experienced with the characteristic crises of great intensity, and affects only one branch of the trigeminal, it is most likely that it is a classic or idiopathic form.

Middle-aged women most affected

Trigeminal neuralgia can affect anyone and any age, but it is true that neurologists have observed how middle Ages The onset of the disease is around 54 years and is more common in women (in 60% of cases).

In any case, it is a disease whose incidence increases with age: with a general incidence of 12.6 cases per 100,000 people per year, this progresses to 17.5 per 100,000 people/year among people aged 60 to 69 years or up to 25.6 per 100,000 people/year in people over 70 years of age. Trigeminal neuralgia accounts for 90% of neuralgia that occurs in people over 60 years of age.

Diagnostic problems

Although these data are not definitive since the SEN suggests that the incidence of the disease could be higher due to diagnostic problems.

And, although there are well-defined criteria to detect trigeminal neuralgia, it is estimated that, in developed countries, the diagnosis is delayed by at least a year and that the first consultation results in an erroneous diagnosis in more than 40%. from the patients.

“It is common that, at the first consultation, trigeminal neuralgia is confused with other diseases, especially dental problems. On the contrary, many patients with intense facial pain without an obvious cause are mistakenly diagnosed with trigeminal neuralgia,” says Dr. Pablo Irimia.

“For this reason, the SEN has developed a guide accessible to all doctors for the diagnosis and treatment of trigeminal neuralgia. Trigeminal neuralgia is one of the most intense and debilitating forms of pain that a person can experience, which is why it is urgent to improve diagnosis times so that patients can access the indicated treatments as soon as possible,” concludes the expert.

From drugs to surgery for treatment

Although it is a chronic disease that cannot be cured, there are treatments to relieve or try to make trigeminal neuralgia subside. Thus, more than 60% of patients can benefit from existing pharmacological treatment.

For those patients who do not respond to drugs, there are other treatment alternatives, such as local infiltration of Botulinum toxin or certain surgical procedures. In fact, more than 30% of patients who do not respond to medical treatment are candidates for surgery. So currently, approximately 80-85% of patients are pain-free in the long term.

“In any case, and although many patients undergoing treatment achieve complete remissions, especially at the beginning, we are talking about a chronic disease that is difficult to manage, in which the drugs may not be effective or may lose effectiveness over time and whose “The impact on the quality of life of patients is very relevant,” warns the neurologist.

This has serious consequences for patients.

• “We know that the incidence of depression and anxiety in patients with trigeminal neuralgia is almost three times higher than in the general population, that more than 50% of patients have work limitations and that many patients experience significant limitations in activities. of daily life, Social isolationor suffer from other types of comorbidities such as sleep disturbances, fatigue or anorexy”, adds the expert.

“It is urgent, therefore, to try to improve diagnosis times and research new treatments that will reduce the uncertainty with which many patients live due to the lack of diagnosis, the fear that the attacks will be repeated, the possible effects secondary to the treatment or to the loss of effectiveness thereof,” concludes Irimia.