Trigeminal neuralgia – severe pain in the face

A relaxed Sunday morning breakfast. When chewing the delicious roll, a sharp pain shoots up in one half of the face. Although this is over after a few seconds, it is so intense that tears come. The name says it all: the trigeminal nerve, the triplet nerve, is the name of the fifth cranial nerve; neuralgia means nerve pain.

Where does the pain in trigeminal neuralgia come from?

In the case of trigeminal neuralgia, one, more rarely two, of the three branches of one of the two trigeminal nerves, which symmetrically supply large parts of the face, usually hurts:

  • the first branch, rarely affected, conveys sensations from the lacrimal gland, orbit, and forehead
  • the second, most commonly affected branch supplies facial skin, nasal mucosa, upper lip, and maxillary teeth
  • the third branch conveys sensations in the lower jaw area and supplies the masticatory and floor of the mouth muscles.

In Germany, about every 3,000. It is affected by trigeminal neuralgia, mainly people aged 50 to 70, women somewhat more often.


How does trigeminal neuralgia develop?

Depending on the cause, the much more common classic trigeminal neuralgia is differentiated from secondary trigeminal neuralgia, which arises from other disorders. In the first form, the nerve is irritated by a tight-fitting loop of blood vessels for years and its protective covering is eventually damaged. This leads to a “short circuit” between otherwise separate nerve fibres, so normal stimuli such as touch are perceived as a pain sensation.

In secondary trigeminal neuralgia, nerve damage occurs, for example, due to pressure from a tumour, herpes viruses or as part of multiple sclerosis. Since the cause of the classic form was unknown for a long time, one also speaks of the idiopathic (“with an unknown cause”) and the non-idiopathic form.

How does trigeminal neuralgia manifest itself?

Primary headache and facial pain can present with a wide range of symptoms. The pain can last from a few seconds to years. The concise attacks, lasting a maximum of two minutes, are typical of classic trigeminal neuralgia. Still, they can occur up to a hundred times a day and are extremely painful – not surprising since the triplet nerve supplies the usually susceptible facial area.

The pain shoots up like a flash, is described as stabbing or burning and is localized exactly in the supply area of ​​the affected trigeminal branch.

It is also typical that the attacks are often triggered by touching the area or certain activities: chewing, speaking, brushing teethshaving, etc. Sometimes, tears or salivation, skin redness or muscle twitching also occur in the affected half of the face.

The pain is usually so unbearable that sufferers lose a lot of weight for months because they are afraid to chew, and they are often suicidal. Suppose the trigeminal nerve is irritated by another underlying disease or, for example, a root canal treatment. In that case, the symptoms can also be atypical: the pain lasts longer but is less severe, or the skin in the area supplied by the nerve is numb.



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