Also called “trigeminal neuralgia”, facial neuralgia is the irritation of one of the 12 pairs of cranial nerves that innervate the face, the trigeminal nerve, or nerve number 5. It is manifested by severe pains that affect a patient. side of the face . The pain, similar to electric shocks, occurs during certain stimulation as banal as brushing teeth, drinking, chewing food, shaving or smiling. We know that 4 to 13 people in 100,000 are affected by facial neuralgia. Another characteristic sign of the disease is the existence of a contraction of the facial muscles related to the pain, similar to a grimace or a tic. Because of this, facial neuralgia is sometimes referred to as ” tic pain “.
Causes of Neuralgia facial (trigeminal)
Facial neuralgia is the irritation of the trigeminal nerve, responsible for the innervation of a part of the face and sends back pain messages to the brain. Several hypotheses exist on the causes of this irritation. Most often, facial neuralgia is probably related to contact between the trigeminal nerve and a blood vessel (especially the superior cerebellar artery). This vessel exerts pressure on the nerve and disturbs its normal functioning. Another hypothesis advanced, the existence of intense electrical activity of the trigeminal nerve, like epilepsy, explaining the effectiveness of antiepileptic treatments in facial neuralgia. Finally, trigeminal neuralgia is sometimes secondary to pathology in 20% of cases, neurodegenerative disease, multiple sclerosis, tumor, aneurysm, infection (shingles, syphilis ..), and trauma compressing the nerve. In many cases, no cause is found.
In the absence of effective treatment, facial neuralgia is a serious handicap in everyday life. When it continues, it can lead to depression and even, in some cases, suicide.
When to consult
Do not hesitate to consult your doctor if you feel frequent pain in the face, especially if the usual painkillers (paracetamol, acetylsalicylic acid …) can not relieve you.
There is no specific test or additional examination for the definite diagnosis of facial neuralgia . It is thanks to the very peculiar aspect of the pain that the doctor is able to make the diagnosis, even if, the symptoms of the facial neuralgia are sometimes wrongly attributed to the jaw or the teeth, thus causing maxillary or dental interventions. useless.
symptoms of Neuralgia facial (trigeminal)
At the very beginning, painful seizures can be mild and short-lived (a few seconds). As the disease progresses, the disease progresses, leading to an exacerbation of pain and an increase in the duration and frequency of seizures. There is no pain between each crisis. Over time, these periods of remission that can last several months or years become shorter and shorter.
Facial neuralgia is characterized by:
- Flash unilateral acute painful bursts (on one side of the face) , extremely intense , similar to electric shock, crushing or a tear, which appear at the lips , the jaw , the gums , the cheeks, the chin and more rarely at the forehead. Seizures can last from seconds to minutes;
- Most often spontaneous pain, but which can also occur in contact with a particular area of the face ( trigger zone ) or under certain circumstances: smiling, talking, blowing nose, shaving, brushing teeth , chew food, smoke, consume coffee or alcohol, or in case of stress, drafts or cold.
- A pain so intense that the patient has to interrupt his activity. Each painful attack is followed by a refractory period of several minutes during which the trigger zone remains silent, allowing the person to resume his activity.
- Recurrent painful seizures similar to electric shocks, recurring at short intervals (a hundred seizures per day in the most severe cases).
- The possibility of bilateral involvement, alternately affecting each side of the face. A situation that remains rare.
- Painful periods that can last for days, weeks, months or even years.
Risk factors for Neuralgia facial (trigeminal)
- Trigeminal neuralgia is three times more common in women, especially after the age of 50.
- Multiple sclerosis is thought to cause 2 to 3% of neuralgia in the face. The deterioration of the myelin sheath protecting the nerves would be involved. In most cases, these are bilateral forms that concern young people.
There is no known way to prevent the onset of facial neuralgia .
Medical treatment of facial neuralgia (trigeminal)
It is usually possible to successfully treat pain with medication, injections, or surgery.
Traditional painkillers (paracetamol, acetylsalicylic acid, etc.) or even morphine (source )cannot effectively relieve facial neuralgia. Other drugs that are much more effective include:
- The anticonvulsant ( antiepileptic ) , having the effect of stabilizing the membrane of nerve cells, often with carbamazepine as first (Tegretol), which allows to remove the painful crises or reduce the frequency and intensity, or Gabapentin (Neurontin), oxcarbazepine (Trileptal), pregabalin (Lyrica), clonazepam (Rivotril), phenytoin (Dilantin), lamotrigine (Lamictal)
- The antispasmodic , such as baclofen (Lioresal) can also be used.
- The antidepressants (amitriptyline or clomipramine), the anxiolytics and antipsychotics(haloperidol) may be used in addition.
Although drug treatments are effective in the majority of cases, approximately 40% of patients end up developing long-term resistance. It is then necessary to envisage a surgical intervention.
There are currently three different techniques available:
- The gamma knife ( gamma- ray scalpel ) consists of irradiating the trigeminal nerve at its junction with the brain with radioactive rays that will cause the partial destruction of nerve fibers. (source 3)
- The percutaneous techniques that to achieve directly the nerve or ganglion using a needle inserted in the skin and under radiological control or strict stereotactic. Three techniques are possible:
- Thermocoagulation (selective destruction of the Gasser ganglion by heat) that removes pain while maintaining the tactile sensitivity of the face. This is the most effective percutaneous method.
- Chemical destruction (glycerol injection)
- The compression of Gasser’s ganglion by an inflatable balloon.
- The microvascular decompression by direct approach of the trigeminal nerve which is to make an opening in the skull behind the ear, in search of the blood vessel responsible for the compression. It is therefore a delicate and invasive procedure.
These neurosurgical procedures can lead to certain complications, such as the loss of sensitivity of the face for example. In some people with trigeminal neuralgia, the pain may return after a few years. The choice of treatment depends on the age, the state of the patient, the intensity of the neuralgia (tolerance to pain and spasm of the person affected), its origin or seniority. In general, surgery is only considered as a last resort.