The Neuralgia It is characterized by repeated attacks of pain located in the territory of distribution of one or more nerves.

The most frequent is the Trigeminal Neuralgia. Its incidence is 8-13 per 100,000 inhabitants/year and increases with age, affecting women more than men. Trigeminal neuralgia is frequently confused with other headaches such as Migraine either Headachewave Tension Headachewhich are completely different.

Symptoms

The patient refers crisis of intense stabbing pain or similar to an electric shock, lasting a few seconds to two minutes, usually unilateral and located in the distribution of one or several nerve branches.

In the case of the Trigeminal Neuralgia (the trigeminal has three branches), it is usually the second or third branch, affecting the area of ​​the nasal wing and upper jaw or the mandible, although sometimes it can manifest in several branches.

The pain can appear spontaneously, or triggered by tactile stimuli, cold, heat, chewing, etc., on certain areas called “trigger zones”.

Typically the patient tries not to talk or chew, touch their face or brush their teeth to avoid pain.

Types of Neuralgia

Depending on their cause, they can be essential, idiopathic (unknown cause) or high schools (due to Tumors, Aneurysms, arteriovenous malformations, trauma, alcohol, Diabetes, infections, inflammatory causes, etc.)

If we take into account the affected nerve, the most common are Cranial Neuralgias: trigeminal, glossopharyngeal, or occipital neuralgia, among others. The Postherpetic Neuralgia produced by the Herpes zosteralso very common, can affect any nerve trunk in the body and usually appears after suffering from Herpes Zoster.

Causes

The shapes calls essential They have no apparent cause that causes nerve injury. The Secondary Neuralgias They are due to the existence of a lesion that invades or compresses the nerve, such as a tumor, vascular malformations, demyelinating diseases (e.g. Multiple Sclerosis), infectious (such as that caused by the Herpes Zoster virus) or others.

In the case of the Trigeminal Neuralgiait has been observed that in many of the patients who have undergone surgery for supposedly essential neuralgia, there were actually blood vessels that were compressing the trigeminal root.

The explanation of how pain occurs would be hyperexcitability of nerve fibers and the transmission of stimuli from the fibers that convey touch to others that convey pain, due to a loss of the substance that surrounds the fibers (myelin), which favors the contact of the axons (the extension of the neurons that conduct the nervous impulse).

Treatments

In the case of the Secondary Neuralgiasthe treatment of choice is cause that originates (resection of tumors, aneurysms, treating infections, etc.)

If it is a Primary Neuralgiaessential or idiopathic, the treatment of choice is pharmacological. The most used and effective drugs are antiepileptics.

Sometimes there are cases of essential neuralgia that do not respond to drugsin which case a surgical treatmentwhich attempts to free the nerve from possible vascular compression, or injure the fibers that conduct pain.

The most used in the Trigeminal Neuralgia They are: thermocoagulation, balloon compression, microvascular decompression of the trigeminal root, radiosurgery with gamma-knife, section of the Trigeminal root, or the so-called Peripheral Neurolysis. Sometimes you have to resort to both types of treatment: doctor and surgical.