It is a disease characterized by recurrent episodes of severe paroxysmal pain in the distribution area of the trigeminal nerve, with an unknown cause, and may also occur secondary to other diseases. It is more common in middle-aged and elderly individuals.

bubble_chart Diagnosis

1. Medical History and Symptoms

Sudden, lightning-like, brief yet intense pain often occurs without warning. The pain may feel like electric burning, stabbing, cutting, or tearing (severe pain). Patients often press or rub the affected side of the face tightly with their palms or a towel in an attempt to alleviate the pain. In severe cases, it may be accompanied by reflexive facial muscle spasm, with the corner of the mouth pulled to one side, along with symptoms such as facial redness, conjunctival membrane congestion, tearing, and drooling, also known as "painful spasm." Each episode lasts only a few seconds to 1–2 minutes before abruptly stopping. During intervals, everything appears normal, and the frequency of attacks can range from once every few days to multiple times per minute.

2. Physical Examination Findings:

Neurological examinations often show no positive signs, but the following may be observed: 1. Trigger zones: Certain areas within the trigeminal nerve distribution on the patient's face are particularly sensitive, and slight stimulation can trigger a pain episode. Common sites include the upper and lower lips, nasal wings, and cheeks, hence these areas are referred to as "trigger zones."

2. Due to pain, patients may avoid washing their face, brushing their teeth, or eating, leading to poor facial and oral hygiene, as well as depression and negative emotions.

3. Auxiliary Examinations:

Primary trigeminal neuralgia often shows no abnormalities in auxiliary examinations. For secondary trigeminal neuralgia, lumbar puncture CSF may show abnormalities. If necessary, internal auditory canal X-rays, cranial CT, or MRI scans may be performed.

bubble_chart Treatment Measures

1. Drug Therapy:

For primary trigeminal neuralgia, carbamazepine or Tegretol 100mg 3 times daily, phenytoin sodium 100mg 3 times daily. Chinese medicinals Scandent Schefflera Stem and Leaf tablets, 4 tablets each time, 3 times daily.

2. Block Therapy:

Inject 5% phenol or 95% alcohol into the trigeminal ganglion or its branches to block nerve conduction and achieve pain relief.

3. Surgical Treatment is divided into:

① Peripheral branch resection;

② Partial resection of the trigeminal sensory root;

③ Trigeminal spinal tract resection;

④ Trigeminal nerve decompression. Surgical treatment may be adopted for those who do not respond to conservative therapy.

4. Secondary Trigeminal Neuralgia:

The primary disease should be actively treated.

bubble_chart Differentiation

Trigeminal neuralgia often needs to be differentiated from trigeminal neuritis, toothache, glossopharyngeal neuralgia, etc.