Diagnosis of trigeminal neuralgia requires a comprehensive assessment through detailed medical history, physical examination, and imaging studies. Treatment includes medication, surgery, and physical therapy. Trigeminal neuralgia is a common facial pain disorder, characterized by sudden, severe facial pain, typically localized to the distribution area of the trigeminal nerve. Diagnosis requires ruling out other possible causes of facial pain, such as toothache and migraines.
1. Medical History Taking: The doctor will ask the patient in detail about the characteristics of their pain, including the location, nature, duration, and frequency of attacks. Trigeminal neuralgia pain is usually paroxysmal, electric shock-like, or stabbing pain, with short duration but frequent attacks. Patients may also have trigger points, where even slight touch or chewing movements can trigger pain.
2. Physical Examination: The doctor will perform a facial sensory examination to assess the sensory function of the trigeminal nerve. Through palpation, temperature sensation, and pain sensation tests, a preliminary assessment of the trigeminal nerve's functional status can be made. The doctor will also examine the patient's masticatory muscle strength and jaw movement to rule out other possible causes of facial pain.
3. Imaging examinations: MRI is the most commonly used imaging method, which can clearly show the anatomical structure of the trigeminal nerve and help rule out organic lesions such as tumors and vascular compression. CT scans can also be used to assess the structure of the skull base and temporal bone, but their diagnostic value for trigeminal neuralgia is relatively low.
4. Drug Treatment: Carbamazepine is the first-line drug for treating trigeminal neuralgia, relieving pain by inhibiting abnormal neuronal discharges. Oxcarbazepine and gabapentin are also commonly used drugs with good analgesic effects. Drug treatment needs to be adjusted according to the patient's pain level and drug response. Long-term use requires attention to the side effects of the drugs.
5. Surgical Treatment: Surgical treatment may be considered for patients who do not respond to drug therapy or cannot tolerate the side effects of medication. Microvascular decompression is a commonly used surgical method that relieves pain by separating the blood vessels compressing the trigeminal nerve. Radiofrequency ablation and Gamma Knife treatment are also effective treatments suitable for patients who cannot tolerate surgery.
6. Physical Therapy: Acupuncture, physiotherapy, and hot compresses can help relieve pain and improve local blood circulation. The choice of physical therapy should be based on the patient's specific condition, and long-term adherence can achieve better results.
The diagnosis and treatment of trigeminal neuralgia require a comprehensive consideration of the patient's specific condition, selecting appropriate examination methods and treatment plans. Early diagnosis and timely treatment can effectively relieve pain and improve the patient's quality of life. Patients should actively cooperate with regular follow-up examinations during treatment to adjust the treatment plan and achieve the best therapeutic effect.