Trigeminal Neuralgia
Facial pain can be discussed as one of the symptoms of trigeminal neuralgia which is a specific neurological disorder that affects trigeminal nerves. This condition is usually observed in persons who are aged between 40 and 60 years, and according to studies, this disorder is most typically observed in women older than 50 years (Al-Quliti, 2015; Cruccu et al., 2016). Thus, the purpose of this paper is to discuss trigeminal neuralgia as one of the differential diagnoses set for facial pain with the focus on patients who are older than 50 years.
Specific signs and symptoms of trigeminal neuralgia include sharp pain in one side of an individual’s face, electric-like bursts of pain, burning sensations, muscle spasms, and bursts of pain in teeth or ears. The pain associated with trigeminal neuralgia is often characterized as extremely intense (Cruccu et al., 2016). Pain and spasms are caused by affecting one of the trigeminal nerves on a person’s face. Such bursts of pain usually last from several seconds to one or two minutes. Unilateral symptoms are more typical for this condition (Torpy, Rogers, & Golub, 2013). The development of pain can be associated with such triggers or activities as shaving, eating, drinking, brushing teeth, and speaking.
Physical findings related to the problem are usually a result of a neurological examination of a person’s face to find out which part of the nerve causes pain. The location of pain helps determine the affected part of a trigeminal nerve (Al-Quliti, 2015). Such pain often has a paroxysmal character (Cruccu et al., 2016). A physician should examine a face to ensure that the reported pain does not extend to other parts of a patient’s head where affected cervical nerves can cause discomfort.
Physicians also need to conduct some tests to ensure that the observed symptoms are associated with trigeminal neuralgia in contrast to other conditions that can provoke facial pain. Diagnostic testing should include other types of physical examinations, as well as conducting computerized tomography tests and magnetic resonance imaging (Falaki, Nejat, & Dalirsani, 2014). These tests are important to demonstrate what parts of nerves are affected and what kind of pressure they experience to plan treatment (Torpy et al., 2013). The analysis of the clinical picture along with the interpretation of test results can help healthcare providers diagnose trigeminal neuralgia among other causes of facial pain.
When the condition is diagnosed, it is important to determine treatment appropriate for patients who are older than 50 years. In most cases, physicians prescribe pharmacological treatment to decrease the intensity of pain and begin to prepare patients for microvascular decompression surgery. This type of treatment is supported by researchers as one of the most appropriate options for older people (Cruccu et al., 2016; Ko et al., 2015; Yang, Wang, Jiang, & Chen, 2014). Another approach is Gamma Knife Radiosurgery which is prescribed not as often as microvascular decompression surgery (Cheng, Lim, Chang, & Barbaro, 2013; Falaki et al., 2014).
It is possible to state that there are many types of facial pain. To determine what condition is observed and diagnose the problem appropriately, it is important to pay attention to the identified symptoms and specific signs typical of this or that disorder. For trigeminal neuralgia, common signs include the prevalence among women aged over 50 years; the experienced pain is sharp and non-prolonged, and only one side of a person’s face is affected. The differential diagnosis based on analyzing symptoms and conducting a physical examination should be supported by scanning.
References
Al-Quliti, K. W. (2015). Update on neuropathic pain treatment for trigeminal neuralgia: The pharmacological and surgical options. Neurosciences, 20(2), 107-114.
Cheng, J. S., Lim, D. A., Chang, E. F., & Barbaro, N. M. (2013). A review of percutaneous treatments for trigeminal neuralgia. Operative Neurosurgery, 10(1), 25-33.
Cruccu, G., Finnerup, N. B., Jensen, T. S., Scholz, J., Sindou, M., Svensson, P.,… Nurmikko, T. (2016). Trigeminal neuralgia. Neurology, 87(2), 220-228.
Falaki, F., Nejat, A. H., & Dalirsani, Z. (2014). The effect of low-level laser therapy on trigeminal neuralgia: A review of literature. Journal of Dental Research, Dental Clinics, Dental Prospects, 8(1), 1-5.
Ko, A. L., Lee, A., Raslan, A. M., Ozpinar, A., McCartney, S., & Burchiel, K. J. (2015). Trigeminal neuralgia without neurovascular compression presents earlier than trigeminal neuralgia with neurovascular compression. Journal of Neurosurgery, 123(6), 1519-1527.
Torpy, J. M., Rogers, J. L., & Golub, R. M. (2013). Trigeminal neuralgia. JAMA: Journal of the American Medical Association, 309(10), 1058-1058.
Yang, D. B., Wang, Z. M., Jiang, D. Y., & Chen, H. C. (2014). The efficacy and safety of microvascular decompression for idiopathic trigeminal neuralgia in patients older than 65 years. The Journal of Craniofacial Surgery, 25(4), 1393-1398.