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Trigeminal neuralgia

The trigeminal nerve is considered the largest nerve in the human body, as it is located in the posterior region of the head. The main branches of the nerve meet in the ganglion, a single large sensory root exits the ganglion and enters the brain stem at the level of the bridge, and a motor root of a smaller size exits the bridge in the immediate vicinity of the sensory root.

Trigeminal neuralgia

Trigeminal Neuralgia

Eyes: it controls the eye, upper eyelid, and forehead.

Upper jaw: It affects the top lip, upper gums, cheek, and lower eyelid.

Lower jaw: it moves the jaw, lower lip, lower gums, and some muscles that you use to chew.

Trigeminal neuralgia is a chronic neuralgia condition that affects the trigeminal nerve, which is responsible for transmitting sensation from the face to the brain.  Even a simple stimulation of the face, such as brushing teeth or applying makeup, can lead to a wave of excruciating pain, and some people describe trigeminal neuralgia as an electric shock.

Initially, short pain attacks may be mild, but trigeminal neuralgia can develop and cause longer bouts of severe pain. It affects women more often than men and is more likely to occur in people over 50 years old.

It should be noted that about 14,000 people are infected with this condition annually in the USA, and it is believed that it affects almost a million people worldwide.

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What are the causes of Trigeminal Neuralgia?

Trigeminal neuralgia can occur as a result of age, or it can be related to multiple sclerosis, or a similar disorder damages the myelin sheath that protects certain nerves. It can also be caused by a tumor that presses on the trigeminal nerve.

Also, some people may experience trigeminal neuralgia due to a brain lesion or other abnormalities. In other cases, surgical wounds, a stroke, or facial trauma may be responsible for the pain of trigeminal neuritis.

Also, triggers of trigeminal neuralgia may include:


Touching the face.

Chewing food, or drinking.

Brushing teeth.


Applying cosmetics.

Washing the face.


Symptoms of three-headed trigeminal neuralgia may include one or more of these:

Attacks of acute and severe pain that resembles an electric shock, or gunshot penetration lasting for a few seconds or minutes.

Spontaneous attacks of excruciating pains caused by very simple stimulation such as: touching the face, chewing, talking, and brushing teeth. This series of attacks may last for days, weeks, months, or longer, and some people may go through a period when they do not feel any pain.

Pain in the areas supplied by the trigeminal nerve includes the cheek, jaw, teeth, gums, lips, less often the eye and forehead. The pain affects one side of the face at a time, although in some rare cases, it affects both sides of the face. The pain is concentrated at one point or spread over a wider area, and the attacks become more intense and frequent over time.


Type: the pain associated with trigeminal neuralgia is sudden, electric shock-like, and for a short time.

Location: by identifying the parts of the face that are affected by pain, it is possible to find out if the trigeminal nerve is responsible for supplying it.

Triggers: the pain associated with trigeminal neuralgia is often pain caused as a result of a very simple and natural stimulus, such as: eating, talking, or even touching the face.

The doctor may also conduct several tests and determine the underlying causes of the condition, including:

Neurological examination: 

The doctor can touch and examine parts of the face, in order to help him determine exactly where the pain occurs. And if it turns out that the patient has trigeminal neuralgia, the branches of the trigeminal nerve may be affected. Reflex tests can also help determine whether the symptoms are caused by pressure on the nerve or by another condition.

Magnetic resonance : 

The doctor may order an MRI examination of the head to determine whether multiple sclerosis or a tumor is causing trigeminal neuralgia. In some cases, the doctor may inject a dye into a blood vessel to see arteries and veins and highlight blood flow (magnetic resonance angiography).

Treatment for trigeminal neuralgia

Treatment of Trigeminal Neuralgia usually begins with medication, some people do not need additional therapy. However, some people with this condition may stop responding to medications, or they may experience side effects. For these people, injections or surgery are other treatment options.

If the condition is due to a known cause, such as multiple sclerosis, the doctor will treat the disease causing the condition.

Medicines for the treatment of Trigeminal Neuralgia

To treat trigeminal neuralgia, the doctor will usually prescribe medications to reduce or block pain signals sent to the brain; including:

Anticonvulsants: such as carbamazepine, and many other drugs. If the used anticonvulsants begin to lose their effectiveness, the doctor may increase the dosage or switch to another type. Anticonvulsant side effects might include nausea, sleepiness, disorientation, and dizziness.

Antispasmodics: Patients who are no longer aided by medicine may benefit from Botox injections to lessen their discomfort. Muscle relaxant pharmaceuticals like baclofen, baclofen, and lyrical may be taken alone or in conjunction with carbamazepine. Before this therapy for this illness is widely utilized, further study must be conducted.

Surgery for trigeminal neuralgia

In most cases, the patient responds to the medication, but sometimes the pain stops responding to the medication, and severe symptoms return, and in these cases, surgery is the optimal option, and there are many surgical options to stop the pain caused by trigeminal neuralgia, which include:

1-removing pressure on the small blood vessels, where the blood vessels that compress the nerve are moved or removed, and this operation is effective in removing and reducing pain, but it is possible that the pain will return again, and the risks of performing this operation are hearing loss, weakness, and numbness in the face, double vision, or a stroke, although the incidence is small.

2-glycerol injection, where glycerol isolates the damaged nerve to prevent it from transmitting pain signals, and it is worth noting that this operation does not cause any damage to the nerve, is done by local anesthesia, and takes a few minutes, and the patient can return home the same day.

3-placing a pressure balloon through the skin next to the nerve is considered an effective procedure, but the pain may return again, and most patients suffer from numbness in the face and more than half of them may suffer from temporary or permanent weakness in the muscles used for chewing.

4-stereotactic radiosurgery is a painless procedure that is performed without the need for anesthesia, where a computer is used to deliver highly focused rays of radiation to the nerve root.

5-radiosurgery using a gamma knife is considered the most popular among other surgical treatments due to its accuracy and effectiveness and because it is considered the safest, and the patient needs several weeks to improve


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