Recently, there was a news report about a patient, Tian Ling, from Shaanxi Province, who had been suffering from toothache for 19 years. During these years, 15 teeth were extracted one after another before she was finally diagnosed as not having toothache at all, but facial trigeminal neuralgia. Experts point out that there is actually a big difference between toothache and trigeminal neuralgia. The latter is often a paroxysmal pain in the jaw, which passes in a few seconds or minutes, only that it is recurrent, while toothache is certainly not so short. More importantly, trigeminal neuralgia has a “trigger point”, i.e. the action of eating, brushing teeth, blowing wind, etc. may inadvertently trigger trigeminal neuralgia. The difference between trigeminal neuralgia and toothache 57-year-old Ms. Tian has been suffering from toothache for 19 years. 19 years, the pain intervals became shorter and shorter, and the pain time became longer and longer, so she had 15 teeth extracted one after another. However, after taking medication, extracting teeth and having surgery, she now realizes that it is not a tooth problem at all, but trigeminal neuralgia that is at fault. Trigeminal neuralgia is a very common disease in neurosurgery, but in clinical practice, it is found that many patients think it is a toothache. In fact, there is a big difference between trigeminal neuralgia and toothache. After the trigeminal nerve emanates from the brainstem, it passes through the skull and innervates the muscles and skin sensations of the face. The first branch is in the eyes and forehead; the second branch is below the eye fissure and above the mouth and lips; and the third branch is in the jaw. Patients with trigeminal neuralgia encountered in clinical practice often present with pain in the third branch, which is the lower jaw. (1) paroxysmal pain in the jaw, each attack lasts from a few seconds to a few minutes, and the intervals are not painful at all and completely normal; (2) the pain during the attack is lightning-like, electric shock-like, electric shock, and severe pain; (3) when washing the face, brushing the teeth, drinking, talking, or even blowing a little cold wind can induce a painful attack; thus, there is still a big difference between toothache and trigeminal neuralgia, and the former often will have periodontitis, dental pulpitis, dental caries, etc. An experienced dentist can completely distinguish trigeminal neuralgia from toothache after examination and treatment. Trigeminal neuralgia occurs mostly in adults and the elderly. According to statistics, 70-80% of cases occur over the age of 40, with the peak age being the 50-year-old group, and more women than men. Presumably, this is because women are more sensitive to pain. There is also a theory that the average age of onset of trigeminal neuralgia is 51 years old, and this is the period of menopause in women, when the hormone level in the body is imbalanced, and trigeminal neuralgia occurs due to osteoporosis, decalcification of the skull bone, and the gradual occurrence of skull base sinking. In clinical practice, there are two types of trigeminal neuralgia. One kind is secondary, that is, brain tumor, brain aneurysm, multiple sclerosis and other causes of facial nerve pain, and the secondary neuralgia will be relieved naturally after the primary disease is cured. This type of secondary trigeminal neuralgia accounts for only about 10% of all patients with trigeminal neuralgia. The remaining 90% of trigeminal neuralgia is “primary trigeminal neuralgia”, that is, no clear cause can be found, but it is certain that a certain blood vessel of the patient is compressing the trigeminal nerve, interfering with its microcurrent signal transmission, producing abnormal current signals, and the patient will feel abnormal pain. As the compression of the nerve by the blood vessel continues, over the years, the damage to the trigeminal nerve becomes more and more severe, and the patient’s pain symptoms become more and more severe. It depends on the pain level. Trigeminal neuralgia is known as the “No. 1 pain in the world” by the neurology department, which means that not many people can stand this pain. However, whether or not treatment is needed depends on how much the pain affects a person’s life and work. Some people’s pain will pass in a few seconds, or the interval between attacks is very long, then the impact on their lives and work is not great, and the patient can tolerate it, so there is no need for treatment. However, if the pain is so severe that the patient cannot live a normal life, it is necessary to treat it early. In clinical practice, we have encountered patients who have painful episodes and like to rub their faces with their hands, and over time their facial skin becomes rough, thickened, and their eyebrows fall off. Recently, we also admitted an 80-year-old woman who had suffered from trigeminal neuralgia for decades and had to come to the hospital for treatment because she was in pain when she ate and could only drink liquid food, suffering from severe malnutrition and losing weight. Other patients have to come to the hospital because they are afraid to eat or wash their faces, and their limbs are thin, emaciated, and depressed. Instead of living a miserable life like this, it is better to treat them as early as possible. Generally speaking, antiepileptic medication is preferred for trigeminal neuralgia to reduce the excitability of nerve ion channels and decrease pain. After a period of medication, some patients can be cured or their symptoms can be relieved, as shown by a reduction in the degree of seizures and a decrease in the number of seizures. When medication is completely ineffective, or when side effects are significant, radiofrequency heat therapy can be used to destroy the trigeminal nerve. Or microvascular decompression may be taken to completely solve the pain problem. In conclusion, there are still many ways to treat trigeminal neuralgia, and some of them are safe and effective. The key is that patients should go to a regular hospital as soon as they start treatment. Pay attention to exclude brain diseases Primary trigeminal neuralgia is definitely not life threatening despite the severe pain. The key is to control the pain with drugs and surgery, and it is not difficult to stop the pain with current medical conditions, but secondary trigeminal neuralgia has very many causes, which are difficult for non-specialists to distinguish, and some secondary trigeminal neuralgia causes may be life-threatening, such as brain tumors and cerebrovascular malformations, which these diseases are in turn fatal. Therefore, this group of patients should undergo a comprehensive neurological examination, including lumbar puncture, skull base and internal auditory tract radiographs, cranial CT, MRI, and nasopharyngeal biopsy to assist in the diagnosis if necessary.