First of all, what is trigeminal neuralgia? How can trigeminal neuralgia be diagnosed early? Trigeminal neuralgia, also known as painful twitching, is divided into primary and secondary, and is characterized by recurrent episodes of transient, severe pain in the trigeminal nerve distribution area of the face. Many patients start with toothache and often first consult a dentist, or even find out that it is trigeminal neuralgia only after tooth extraction. The disease is not uncommon, and epidemiological surveys abroad show that the incidence is about 5/100,000 people per year, and although there are no accurate data in China, there should not be too much discrepancy. So how can trigeminal neuralgia be diagnosed early? First of all, trigeminal neuralgia should be considered as a possibility if any pain in the face occurs. The scope of trigeminal neuralgia must be completely limited to the distribution area of the trigeminal nerve; secondly, the nature of the pain is often sudden and intense knife-like and lightning-like sharp pain, which is called the first pain in the world. Again, there is often a “trigger point”. In other words, there is a part of the face that cannot be touched, but once touched, the pain is triggered immediately. Therefore, many patients are afraid to wash their faces and brush their teeth. If this happens, you should go to the hospital to rule out the possibility of trigeminal neuralgia. There are so many ways to treat trigeminal neuralgia? How to choose? If you type “trigeminal neuralgia” into Baidu, about 923,000 pieces of information will pop up. Various treatment methods are available, which one is the best? It is really hard for ordinary people to identify them all at once. Today, we will try to teach you how to make the right choice. Actually, it is not very difficult to make the right choice. First of all, we need to find out what causes trigeminal neuralgia. There are two types of trigeminal neuralgia: secondary and primary. The so-called secondary trigeminal neuralgia refers to the type of trigeminal neuralgia where the cause of trigeminal neuralgia can be clearly identified, mainly including trigeminal neuralgia caused by various tumors. Yes, you read it right, it is mainly the pain induced by various tumors. This kind of tumor is mostly benign intracranial tumor, which can be considered for surgical removal, and the effect is generally more certain. Therefore, when you have trigeminal neuralgia, the first thing you should do is to have a cranial MRI first to rule out tumor disease. This is very important, and I have seen many typical cases of patients with typical trigeminal neuralgia who have tried multiple treatments around the world for years to no avail, and were later diagnosed with tumor-associated trigeminal neuralgia in my office. Since vascular compression is the etiology of primary trigeminal neuralgia, vascular decompression surgery should be the surgical method of choice for the treatment of primary trigeminal neuralgia. Please note that I am talking about the preferred surgical approach here, not the preferred approach. Why? Because carbamazepine medication is effective in relieving symptoms in the vast majority of patients. Compared to surgical treatment, medication is more acceptable. Therefore, the preferred method for trigeminal neuralgia is carbamazepine medication. The effect of carbamazepine in the early stage is generally more certain, but as the disease develops, the effect of medication gradually becomes worse, or the patient cannot tolerate medication because of various side effects, it is time to choose microvascular decompression surgery. Microvascular decompression surgery is not only the only known treatment method for the cause of the disease, but also a method that does not damage the function of the trigeminal nerve. Under modern conditions, the procedure is highly safe and has a very low complication rate. Its efficiency can reach about 90% in the short term and 75-80% in the long term. Why is it not 100%? Objectively speaking, although we now know that vascular compression can cause neuralgia, there is no conclusive evidence as to why vascular compression can cause pain to occur. Therefore, there may still be other causes of trigeminal neuralgia that we do not currently know about. Second, the understanding and application of the microvascular decompression technique is still in the developmental stage. It is important to know that the earliest effectiveness of this technique was only about 50%. With the continuous development of microsurgical equipment and techniques, as well as the development of electrophysiological monitoring techniques, we believe that the efficiency of the procedure will continue to improve. Objectively speaking, this is already the most positive result among all the methods of trigeminal neuralgia treatment. Other methods such as Gamma Knife and radiofrequency thermal coagulation are mechanically a kind of nerve destruction treatment, which can be achieved by destroying the nociceptive fibers of the nerve and causing the nerve to lose its function temporarily or permanently. In addition to affecting nerve function, their low efficiency or high recurrence rate causes them not to be used as the preferred method after drugs. However, for patients whose drugs are ineffective or who cannot tolerate the side effects, if their own conditions also cannot tolerate surgical treatment, or for patients who do not want to undergo surgical treatment, they can also choose Gamma Knife or radiofrequency thermal coagulation treatment directly.