Trigeminal neuralgia

Lightning-like, seconds long, set off by touch, completely quiet in between: these four details separate the neuralgia from toothache. They can prevent a chain of needless treatments.

Date, number, what set it off, which region of the face. Because the attacks are short, the course is otherwise hard to judge — and the success of a treatment even harder.

That is not a disappointment but a piece of information: nerve pain responds to different medicines. Conversely, a response to an anticonvulsant supports the diagnosis.

Sodium, blood count and liver values in the first weeks and at intervals thereafter. Tiredness and confusion under treatment are often a low sodium and not a worsening of the illness.

Lukewarm water and a soft brush for the teeth, a scarf over the cheek in wind, soft food during a flare. That also prevents eating and mouth care from being given up altogether.

Imaging shows whether a vessel lies against the nerve root. For that form there is a procedure with good prospects — and it also has to be told apart from a facial palsy, which looks different and is treated differently.

Carbamazepine damps conduction in the nerve and works in most people within days — the response is part of the diagnosis. It does not remove the vessel contact at the nerve root; there are procedures for that.

The pain comes like lightning, lasts seconds to two minutes and is set off by touch, chewing, speaking or wind — that time course is the diagnosis. About four to thirteen per hundred thousand people are affected, usually over fifty. Carbamazepine works in about seven to nine out of ten and is raised slowly. Between attacks the area is usually completely pain-free; constant pain points elsewhere.

The attack is extremely short and extremely fierce, then there is quiet. A lasting, dull facial pain speaks rather for something else.

The pain does not change sides. Complaints on both sides are unusual and a reason to look more closely.

Many avoid shaving, brushing their teeth or the wind on one cheek and eat only on one side. That avoidance is itself a diagnostic sign.

A root treatment or an extraction with no improvement at all is one of the commonest roads to the diagnosis — unfortunately a late one.

Neither fits the classic form and both call for imaging. In younger people multiple sclerosis belongs among the considerations.

The commonest wrong turn goes through the dentist’s chair: second-long flashes on the same side of the face are taken for a tooth — and a healthy tooth gets treated.

Not a value for the diagnosis, but the most important one under treatment: the usual medicine can lower the sodium, which causes tiredness and confusion. It belongs checked regularly at the start.

Likewise a check under treatment. Rare but serious effects on the white cells are noticed early this way.

Belong in the first weeks. Together with the sodium and the blood count they make up the small round of checks that keeps this treatment safe.

In people over fifty with new facial or head pain, giant cell arteritis belongs excluded — a different pain, but a confusion with serious consequences.

Without B12 the insulating layer of the nerves is not maintained. A lack causes tingling, numbness and unsteadiness in the dark — and it is one of the few reasons for nerve trouble that can be fully undone if found early.

The nerves cover their energy needs through thiamine. It runs short with alcohol, after stomach operations, with long-lasting vomiting and under water tablets.

Here both count: a lack harms the nerves, and too high an intake over months harms them as well. Supplements therefore belong taken in a dose that has a reason.

Works together with B12. Given alone, folate can improve the blood count while the B12 deficiency goes on damaging the nerves — which is why both are looked at together.

Small studies have tested high-dose B12 alongside; no reliable benefit is shown. The routes that work in this condition are medicines and, when those fail, a procedure.

Often recommended, but not studied for this pain. 200–400 mg a day is harmless — it does not replace a treatment that actually stops the lightning pain.

In pregnancy clearly established against neural-tube defects, otherwise mainly with deficiency. Can mask a B12 deficiency — watch both.

Women are affected more often, and the condition mostly begins after the age of fifty. A link with the hormonal course is suspected but not shown — the difference is described, no more.

The most effective medicine in this condition lowers the sodium in the blood in some of those treated — especially in older people. Tiredness and confusion on the treatment often come from that and not from the illness.

In facial nerve pain cold drinks, chewing and tooth brushing trigger attacks, not particular foods. Soft, lukewarm food in small bites is practical during a flare.

With lasting nerve pain, pain-coping methods are effectively studied. They do not replace the medication but soften the fear of the next attack — which is itself a trigger.

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