Trigeminal neuralgia is a relatively common neurological disease, which can not be cured because the cause of morbidity is not clear. Trigeminal neuralgia mostly occurs in middle-aged and elderly people, with a prevalence rate of 182/100000, in which women are more than men, and the ratio of men to women is 2:3. At the same time, people with chronic diseases such as hypertension, hyperlipidemia and arteriosclerosis are more likely to suffer from trigeminal neuralgia.
Trigeminal neuralgia has a wide range of morbidity, ranging from 10 to 90 years of age, and has been reported morbidity. Recently, morbidity in children has also increased. Primary trigeminal neuralgia mostly occurs in middle-aged and elderly people, with a prevalence rate of 182/100000 and an annual incidence rate of 4 to 4.7/100000. 70% to 80% of the cases occur in people over 40 years old, with a peak age of 50 years old. Secondary trigeminal neuralgia mostly occurs in young and middle-aged people, which is very rare in clinic and has a very low incidence.
Trigeminal neuralgia can be divided into primary (symptomatic) trigeminal neuralgia and secondary trigeminal neuralgia, of which primary trigeminal neuralgia is more common. Primary trigeminal neuralgia refers to trigeminal neuralgia for which the exact cause cannot be found. Secondary trigeminal neuralgia refers to trigeminal neuralgia caused by tumor compression, inflammation and vascular malformation. This type is different from the primary characteristics, the pain is often persistent, and the pathological signs of the adjacent structures of the trigeminal nerve can be detected.
The etiology and morbidity mechanism of
primary trigeminal neuralgia are still unclear, but most people believe that the lesion is around the trigeminal nerve, that is, in the sensory root of the trigeminal semilunar ganglion. According to microsurgical and electron microscopic observations, it may be related to small vascular malformations, petrous bone malformations and other factors, which cause pain attacks.
Trigeminal neuralgia belongs to paroxysmal pain in terms of
onset time. That is to say, it hurts for a while, it doesn’t hurt for a while, it doesn’t hurt for a whole day or a few days, and it usually hurts for a while.
The nature of
pain is similar to “electric shock-like pain”. The pain travels in the direction of the nerve and travels to the face or ears as soon as it breaks out, feeling like electricity. Some severe pain is like a knife cut, also known as “knife-like pain”.
In terms of
pain location, only the pain in the area of trigeminal nerve distribution is trigeminal neuralgia. Pain in other parts does not belong to trigeminal neuralgia.
In terms
of predisposing factors, trigeminal neuralgia has some common predisposing factors, such as washing face, brushing teeth, eating, talking and so on. Some patients have special places on the face that hurt when touched, such as on the lips or next to the nose. We call this the “trigger point,” which is where the pain is triggered.
Because of the pain in the face, primary trigeminal neuralgia often appears in several “false faces”, which leads to patients “seeking the wrong doctor” and doctors “judging the wrong case”.
1. Toothache
In the early stage of morbidity
of trigeminal neuralgia, it is most likely to be misdiagnosed as toothache, and many patients even pull out all the teeth on the affected side, which fails to relieve the pain. “But in fact, trigeminal neuralgia and toothache are very different. Trigeminal neuralgia is characterized by electric shock-like, knife-like and tearing pain, sudden stop, while toothache is characterized by persistent dull pain or jumping pain. Moreover, toothache can be identified by X-ray or CT examination.”
2. Trigeminal neuritis
Patients usually have a short history of inflammatory infection, and the pain is usually persistent and can be exacerbated if it compresses the site of the infected branch. Trigeminal neuralgia usually lasts only a few seconds to tens of seconds at a time.
3. Intermediate neuralgia
Pain is mainly located in one side of the external auditory canal, auricle and mastoid process, and can radiate to the ipsilateral face, lateral tongue, pharynx and occipital, so it is easily confused with trigeminal neuralgia. “But in fact, the pain of intermediate nerve is usually only a paroxysmal burning pain, which lasts for several hours or even minutes.”. Moreover, intermediate neuralgia is often accompanied by herpes zoster, and there may be peripheral facial paralysis, taste and auditory changes.
4. Sphenopalatine neuralgia
Although the location of pain is similar to that of trigeminal neuralgia, the onset of sphenopalatine neuralgia usually lasts for several minutes to several hours, accompanied by swelling of nasal mucosa on the affected side, nasal obstruction and increased nasal secretion. At the same time, it may be accompanied by tinnitus, deafness, tears, photophobia and burning and tingling of the lower jaw skin. Trigeminal neuralgia does not have these symptoms.
5. Migraine
Although the nature of migraine pain is also severe headache, pulsatile, tingling and tearing pain or swelling pain, but also repeated attacks, but migraine is generally induced by fatigue, menstruation, emotional agitation, each attack will be preceded by aura, such as blurred vision, flash, scotoma, eye swelling and so on. Moreover, it is usually accompanied by nausea, vomiting, tears, pallor or flushing and other symptoms.
6. Glossopharyngeal neuralgia
The nature of
pain is also a sudden attack, a sudden stop, and the duration of each attack is the same as that of trigeminal neuralgia, which is also a few seconds or tens of seconds. It is also a sharp pain like needling, knife cutting, burning, tearing and electric shock. However, unlike trigeminal neuralgia, the pain of glossopharyngeal neuralgia is located at the root of the tongue, throat, tonsil, deep ear and posterior mandible of the affected side, sometimes with deep ear pain as the main manifestation.
