Idiopathic Stabbing Headache

Trigeminal neuralgia: a riddle

Author:

Altaf Malik HM

Department of Oral and Maxillofacial

Govt. Dental College, Srinagar.

Co-authors:

Dr. Ajaz Shah A

Associate Professor and Director,

Department of Oral and Maxillofacial

Govt. Dental College, Srinagar.

Dr. Suhail Latoo

Speaker

Department of Oral Pathology and Microbiology,

Govt. Dental College, Srinagar.

Dr. Manzoor Ahmad Malik

J & K Health Services, SDH Banipora

Dr. Rubeena Tabasum

Resident

CD Hospital, Srinagar.

Dr. Shazia Qadir

Department of Oral and Maxillofacial

Govt. Dental College, Srinagar.

Definition

            Trigeminal neuralgia (TN - tic) is a disorder of the fifth cranial (trigeminal) nerve that causes episodes of intense, throbbing pain of electric shock, as in areas where facial nerve branches are distributed - lips, eyes, nose, scalp, forehead, upper jaw and lower jaw.

Historical note

• • In 1900, in a reference article, Cushing reported a method of complete removal of the Gasserian ganglion to treat TN.
  • In 1912, Osler described TN as follows:
    • In patients with advanced TN paroxysms in rapid succession and without assignable cause, and in the intervals, the patient may never be completely painless.
    • They are initiated by almost any kind of external stimulus, eg an air stream, and the movement of facial muscles or tongue while speaking, contact with the skin, especially on points where pain seems to originate, and the act of swallowing, especially when the pain involves the area of the lining of the distribution of the nerve.
    • This is not a self-limited disease. In some cases, the neuralgia reached such intensity that it makes frightening the patient's life intolerable. In the past suicide was not a rare consequence.

Pathophysiology:

• Usually no structural lesion is present, although many researchers agree that the vascular compression, arterial or venous loops usually at the entrance of the trigeminal nerve in the pons is essential for the pathogenesis of idiopathic variety. This compression of the trigeminal nerve focal demyelination.
• Since the exact pathophysiology remains controversial, TN may have a central and / or peripheral etiology.

CAUSES

It is not always possible to determine what causes trigeminal pain. However, several possibilities exist.

The compression of the nerve root. Compression of the nerve root is now often regarded as the essential cause of classical trigeminal neuralgia. However, other opinions exist yet. In this case, a small blood vessel clip the root of the trigeminal nerve. The spasms may be due to the pulsation of blood vessel compressing the nerve even more.

Damage to the myelin sheath. Damage to the myelin sheath may cause pain of trigeminal. This type of damage usually occurs within the context of multiple sclerosis (MS). As a fairly simple, the damage can be considered as a kind of short-circuit the way it is presented in picture 2 (not included here, as I have no scanner, sorry ...). Normally, sensations of pain and heat are transmitted by different neural pathways. The myelin sheath of nerves isolates of these roads from each other. If e.