[Pre-diagnosis Information] Features of the diagnosis of trigeminal neuralgia

Trigeminal neuralgia is a kind of severe paroxysmal neuralgia that occurs repeatedly in the distribution area of ​​the facial trigeminal nerve. It is one of the common diseases in neurosurgery, with the highest incidence during the age of 50-70. With the development of the disease, the attacks become more frequent, the intermittent period will be shortened, and the pain will also increase and become severe, so that the patient is depressed and even unhappy. 1. Gender and age: most of them are over 40 years old, mostly middle-aged and elderly. There are more women than men, about 3:2; 2. Pain areas: more on the right side than on the left, the pain spreads from a certain point on the face, mouth or jaw to one or more branches of the trigeminal nerve, with the second branch, The third branch is the most common, but the first branch is rare. The pain range does not exceed the midline of the face, nor does it exceed the distribution area of ​​the trigeminal nerve. Occasionally, patients with bilateral trigeminal neuralgia account for 3%; 3. The nature of the pain: severe and unbearable pain such as undercutting, acupuncture, tearing, burning or electric shock, even painful; 4. The law of pain: trigeminal neuralgia The onset of pain is often without warning, and the onset of pain is generally regular. The duration of each pain episode ranges from only a few seconds to 1 to 2 minutes and stops suddenly. At the initial onset, the number of attacks is small, and the intermittent period is long, ranging from several minutes to several hours. As the disease progresses, the attacks become more frequent, the intermittent period gradually shortens, and the pain gradually increases and becomes severe. Pain episodes decreased at night. No discomfort during the intermittent period; 5. Precipitating factors: talking, eating, washing face, shaving, brushing teeth and wind blowing can induce pain episodes, causing the patient to be depressed, acting cautiously, and even afraid to wash, brush teeth, eat, or talk Also be careful, lest it cause an attack; 6. Trigger point: The trigger point is also known as the “trigger point”, often located on the upper lip, nose, gums, corners of the mouth, tongue, eyebrows, etc. Touching or stimulating the trigger point can trigger a painful attack; 7. Expression and facial changes: When the attack occurs, you often suddenly stop talking, eating and other activities, and the painful side may show cramps, that is, “pain cramps”, frowning, gritting teeth, opening your mouth and covering your eyes. Or rub the face with the palm of your hand vigorously, resulting in local skin roughness, thickening, loss of eyebrows, conjunctival hyperemia, tearing and salivation. The expression is in a state of nervousness and anxiety; 8. Nervous system examination: no abnormal signs, a few have decreased facial sensation. Such patients should ask for further medical history, especially if they have a history of hypertension, and perform a comprehensive neurological examination, including lumbar puncture, skull base and internal auditory canal photography, brain CT, MRI, etc., to help Identification of secondary trigeminal neuralgia.

What are the early symptoms of trigeminal neuralgia?

& nbsp. & nbsp. Trigeminal neuralgia disease has a high incidence in China and has become a common disease. It has a great impact on patients’ daily life and learning, and now the survey found that this disease is not just a “patent” for middle-aged and elderly people. There is a trend towards younger development, and this development has caused us to panic. & nbsp. & nbsp. Primary trigeminal neuralgia refers to trigeminal neuralgia where the exact cause cannot be found. Secondary trigeminal neuralgia refers to trigeminal neuralgia caused by tumor compression, inflammation, and vascular malformations. This type is different from the primary characteristics, the pain is often persistent, and can detect the signs of lesions in the adjacent structure of the trigeminal nerve. The etiology and pathogenesis of primary trigeminal neuralgia are unclear, but most believe that the lesion is around the trigeminal nerve, that is, within the sensory root of the trigeminal nerve. According to microsurgery and electron microscopy observations, it may be related to small blood vessel deformities, bone deformities in rock bones and other factors, which may cause pain attacks. & nbsp. & nbsp. It is generally believed that the diagnosis of trigeminal neuralgia should have the following characteristics: & nbsp. & nbsp.1. Gender and age: more than 40 years old, mostly middle-aged and elderly. More women than men, about 3: 2. & nbsp. & Nbsp.2. Pain site: right side is more than left side, the pain spreads to a branch or branches of the trigeminal nerve from a certain point on the face, mouth or mandible. The second and third branches are the most common, and the first branch is rare. The range of pain does not exceed the midline of the face, nor the distribution area of ​​the trigeminal nerve. Occasionally have bilateral trigeminal neuralgia, accounting for 3%. & Nbsp. & Nbsp.3. Pain properties: such as backcut, acupuncture, tearing, cauterization or electric shock-like severe and unbearable pain, even painless. & Nbsp. & Nbsp.4 3. The regularity of pain: Trigeminal neuralgia often has no warning, and pain attacks are generally regular. The duration of each pain attack suddenly stopped from only a few seconds to 1 to 2 minutes. At the beginning of the disease, the number of seizures was small, and the intermittent period was also long, ranging from several minutes to several hours. With the development of the disease, the seizures became more frequent, the intermittent period gradually shortened, and the pain gradually increased and became severe. Night pain episodes are reduced. No discomfort during the intermittent period. 5. Inducing factors: Talking, eating, washing face, shaving, brushing teeth, and blowing wind can all induce pain attacks, causing the patient to become mentally depressed, and act cautiously, even dare not wash his face, brush his teeth. , Eat, and speak carefully, lest cause an attack. & Nbsp. & Nbsp.6, Trigger point: Trigger point, also known as “trigger point”, is often located in the upper lip, nose, gums, corners of the mouth, tongue, eyebrows, etc. Touching or stimulating the trigger point can stimulate the pain. & Nbsp. & Nbsp.7, Expression and facial changes: Suddenly stop talking, eating and other activities during the attack, the side of the pain can show spasms, that is, “painful spasm”, frown and teeth, Cover your eyes with your mouth open, or rub your face vigorously with your palms to cause localized skin roughness, thickening, eyebrow loss, conjunctival hyperemia, tearing, and salivation. The expression is in a state of nervousness and anxiety. 8. Neurological examination: no abnormal signs, and a few have facial sensations. Such patients should further ask about the medical history, especially whether they have a history of hypertension, and conduct a comprehensive neurological examination, including lumbar puncture, skull base and internal auditory canal radiography, cranial CT, MRI, etc., if necessary, to help with Identification of secondary trigeminal neuralgia. & nbsp. & nbsp.

Is facial pain a trigeminal neuralgia? How do you judge?

Trigeminal neuralgia is a nerve problem that occurs in the face. The onset time of the pain has a certain regularity. The early onset of trigeminal neuralgia is very short, lasting only a few seconds to a few minutes, and then suddenly stops. The number of early attacks is less, the intermittent period is also long, and there is no discomfort during the intermittent period (only severe patients can remain in the intermittent period Sustained mild dull pain), and then suddenly attack after a period of time. With the development of the disease, the intermittent period is gradually shortened, generally ranging from several minutes to several hours. The number of attacks is gradually frequent, and the pain becomes more and more severe. Severely ill patients can have several attacks per minute, usually only during the day, with mild or no attacks at night, and severely ill patients with attacks at night, or even more than the whole day. Can not fall asleep all night due to pain attack, or wake up awake after falling asleep, so that day and night can not be peaceful. Trigeminal neuralgia can be a periodic episode, each episode can last for several weeks to several months, after which the symptoms will disappear on their own, or significantly relieved. During this period of remission, patients often no longer have seizures, but after a period of time, severe pain recurs repeatedly, and the chance of self-healing is very small, but more and more frequently, and the pain level increases. Therefore, treatment of trigeminal neuralgia is very necessary. Trigeminal neuralgia also has a great relationship with emotions, so patients should maintain an optimistic attitude in daily life, because an optimistic attitude is conducive to reducing the occurrence of pain. This is because about 45% of patients with trigeminal neuralgia have vascular compression in the region of the brain stem (REZ) of the trigeminal nerve. The cause is related to the compression of the root of the trigeminal nerve by the blood vessel. Although the trigeminal neuralgia attacks, the patient’s pain is unbearable. With proper treatment, there is a chance to cure the cause of the cause. It is necessary to remind that if you correctly understand the pain characteristics and trigger points of trigeminal neuralgia, you can avoid the frequency of attacks in daily life. Trigger neuralgia trigger points and triggers: The triggers of trigeminal neuralgia are also different from person to person, 40% -50% of patients’ faces are in the distribution area of ​​the invading branch, and there are one or more particularly sensitive trigger points or triggers Point, a little early winter can cause pain attacks, and immediately launched to other parts. Trigger points vary in size, and the smaller one is a point or a beard. Trigger points mostly occur on the upper and lower lips, nose wings, nasolabial folds, gums, cheeks, corners, beards, etc. There are also a few trigger points outside the distribution area or range of the mandible or trigeminal nerve, such as the neck. The trigeminal nerve’s third branch of pain is mostly caused by mandibular movements (chewing, yawning, talking, etc.), which directly stimulates the skin trigger point to induce fewer pain attacks. The second branch of pain is usually caused by stimulating the skin trigger points (1/3 of the upper lip, nasal cavity, upper incisors, cheeks, and inside of the eyeball). Drinking hot and cold water, blowing your nose, brushing your teeth, washing your face, shaving, etc. can also be induced. In severe cases, it can also be induced when you move your body to drive your head. Therefore, the quality of life of patients is seriously affected. Some patients do not dare to wash their face, shave, brush their teeth, etc. on the affected side for a long time, so that the diseased side is full of dust, greasy or food residues stored in the gums or cheeks. In addition, combing hair, coughing, sneezing, and breeze blowing the face can also cause pain, sometimes without any external cause can also cause seizures, causing patients to be panic-stricken all day long, depressed, and act carefully. Trigeminal neuralgia symptoms Trigeminal neuralgia is paroxysmal, without any discomfort during the intermittent period, just like ordinary people, (only severe patients can still have sustained mild dull pain during the intermittent period), and can suddenly relapse after a period of time. The intermittent period ranges from a few minutes to several hours or more than 10 hours. With the development of the disease, the seizures become more frequent, the intermittent period gradually shortens, and the pain gradually increases and becomes severe. Severe cases can occur several times per minute, usually only during the day, and the night attacks are mild or stop, and severe patients can also attack at night, so that the end of the day. Because of the onset of pain, people cannot sleep through the night or wake up awake after falling asleep, so there is no rest day and night. The time limit and period of pain attack 1. Trigeminal neuralgia is a periodic attack. The time of each pain attack is abruptly stopped from a few seconds to 1 ~ 2 minutes. 2. The period of each attack can last from several weeks to several months. Alleviated and disappeared or the light was relieved (a few days to several years). 3. During remission, patients often expect no more attacks, but after a period of time, severe pain relapses and there is little chance of self-healing, but more and more frequent, and the degree of pain also varies.

[Before consultation] What are the causes of trigeminal neuralgia? How to choose the treatment method?

Trigeminal neuralgia severely affects patients’ confidence in normal work and even life. Trigeminal neuralgia has a high incidence rate, mostly after the age of 40, and there are many women with an incidence rate of about 50 / 100,000. Trigeminal neuralgia, known as “the first pain in the world”, is a discharge-like, knife-like pain that occurs on the face. Brushing your teeth, washing your face, talking, and even swallowing can cause pain. The pain is paroxysmal and lasts for seconds or minutes. . Trigeminal neuralgia is divided into “primary” and “secondary”. & nbsp. 1. Primary trigeminal neuralgia: no exact cause can be found, and more common clinical features suddenly occur, mostly on one side. The pain was severe like a knife cut or electric shock during the attack, lasting a few seconds to 1-2 minutes, often accompanied by facial muscle twitching, tearing, drooling, flushing, conjunctival congestion and other symptoms. With the aggravation of the condition, the intermittent period is more and more Short, more frequent attacks. & nbsp.1. Gender and age: The majority of people are over 40 years old, mostly middle-aged and elderly. There are more women than men, about 3: 2. & nbsp.2. Pain site: The right side is more than the left side. The pain spreads from a certain point on the face, mouth, or mandible to one or more branches of the trigeminal nerve. The second and third branches are the most common. The first Supporters are rare. The range of pain does not exceed the midline of the face, nor the area where the trigeminal nerve is distributed. Occasionally, bilateral trigeminal neuralgia accounted for 3%. & nbsp.3. Pain properties: such as backcut, acupuncture, tearing, cauterization or electric shock-like severe and unbearable pain, even painless. & nbsp. 4, the law of pain: the onset of trigeminal neuralgia is often unpredictable. The duration of each pain attack suddenly stopped from only a few seconds to 1 to 2 minutes. At the beginning of the disease, the number of seizures was small, and the intermittent period was also long. As the disease progressed, the seizures became more frequent, and the intermittent period gradually shortened, and the pain gradually increased and became severe. Night pain episodes are reduced. No discomfort during the interval. 5. Inducing factors: Talking, eating, washing the face, shaving, brushing teeth, and blowing wind can all induce pain attacks, so that the patient can not be panic all day long, mentally depressed, and act cautiously, lest cause an attack. & nbsp.6. Trigger point: Trigger point is also called “trigger point” and is usually located at the upper lip, nose, gums, corner of mouth, tongue, eyebrow, etc. Tapping or stimulating the trigger point can trigger pain episodes. & nbsp.7. Expression, facial and facial changes: Suddenly stop talking, eating and other activities at the time of the attack. The side of the pain may show spasms, that is, “pain spasms”, frown and teeth, open the eyes, or rub the face with the palm of the hand to rub the face so that local skin Roughness, thickening, loss of eyebrows, conjunctival hyperemia, tearing and salivation. The expression is nervous and anxious. & nbsp. Second, secondary trigeminal neuralgia Secondary trigeminal neuralgia is also called symptomatic trigeminal neuralgia. It is trigeminal neuralgia caused by various organic diseases inside and outside the skull. Similar to the appearance of primary trigeminal neuralgia in facial and facial pain attacks, but the degree of pain is mild, the duration of the pain attacks is longer, or it is persistent pain, which is exacerbated. & nbsp. Mostly seen in middle-aged and young people under 40 years old, usually without trigger point, the precipitating factors are not obvious. Sometimes the onset of secondary trigeminal neuralgia is very similar to primary trigeminal neuralgia. If you do not pay attention to the subtle manifestations of the early stage of secondary lesions, it is easy to be misdiagnosed. General CT and MRI of the head can find the primary disease. Because pain symptoms are unbearable at each attack, in order to be able to stop the pain as soon as possible, many patients are rushed to the doctor and blindly choosing the wrong treatment method will lead to serious complications. So, what are the standard treatment methods for trigeminal neuralgia? The drug treatment of trigeminal neuralgia (carbamazepine, oxcarbazepine, antan, etc.) can play a temporary analgesic or relieving role. These drugs are resistant, and the oral dose is gradually increased, and the effect is getting worse. The side effects are relatively large, and long-term service can cause neutropenia, simple platelet reduction, lead to blood disease, and can cause memory loss, vision, hearing loss, liver function damage and so on. Closed-loop treatment of trigeminal neuralgia: It is a point injection of drugs (anhydrous alcohol, glycerin, vitamin B1, vitamin B2, etc.) to paralyze the nerves and play a temporary relief of symptoms. But the side effects are large, which can cause facial paralysis and sensory disturbance. If the closure deviation can cause blindness and blindness, the pain relief effect after multiple closures is not good. Radiofrequency treatment of trigeminal neuralgia, and