The diagnosis of trigeminal neuralgia is generally easy. The diagnosis is based on the clinical manifestations of the patient and generally no special auxiliary examination is required. When secondary trigeminal neuralgia is suspected, a targeted examination should be performed.
The main diagnostic points of trigeminal neuralgia are as follows.
1. The site of pain onset is the distribution area of the trigeminal nerve or one of its branches. This kind of severe pain appears at the site, generally in the 1st branch for the forehead, upper lid, eye and nose; the 2nd branch for the upper lip, lower lid, paranasal, maxillary, upper teeth and gums; the 3rd branch for the lower lip, preauricular, frontal, lower teeth and their gums and tongue.
A few patients with trigeminal neuralgia have the same paroxysmal severe pain in the region of the greater occipital nerve and below the angle of the mandible. One case of trigeminal neuralgia with paroxysmal severe pain at 75 px behind the ear has been reported abroad, and all these patients achieved complete analgesia after semilunar ganglion injection. It must be noted when diagnosing.
2. Most of them are sudden onset of paroxysmal severe pain, and the vast majority of patients have no pain at all when they do not have an attack, and only a very small number of patients still have mild pain. The painful attacks come suddenly and stop suddenly. In some patients, the first attack is a very severe pain; in some patients, the attack is mild at the beginning, and then gradually worsens. When the disease attacks, patients mostly complain of “Huo Huo” jumping pain, some say like a knife cut, burning pain, forcing patients to rub the face, often swollen and broken skin, some will be eyebrows and beard rubbed out, some are frequent cries, or tight pressure on the pain, or open wide mouth afraid to close. At the same time, the affected side of the lacrimation, salivation and nasal fluid.
The pain can strike dozens to hundreds of times day and night. Some patients may get up from sitting or roll around on the floor, and after a few minutes, the pain suddenly stops and they sit peacefully again. General analgesic drugs are completely ineffective, but a few patients do not have such severe pain, but episodic “numbness”, which can also be cured after the injection of semilunar ganglion.
Most patients have “trigger points”, i.e., trigger points, which can cause painful attacks, but the attack has just passed, and then stimulating the “trigger points” will not cause attacks. Common trigger points are as follows: at the eyebrows, eyes, next to the nose, below the upper corners of the mouth, around the teeth and tongue. Touching these places can cause a seizure; however, just after the seizure is over, although touching these points no longer causes a seizure, which is another diagnostic feature of this disease.
Most of the “trigger points” are in the same nerve branch. In some rare cases, some of the more distant “trigger points” occurred in the ipsilateral thumb, the ipsilateral toe, and in one case, when the right upper limb was moved, it caused a severe painful attack on the right side of the face. Some of them occurred in the back.
4.More than 95% of trigeminal neuralgia patients are unilateral.
5.The pain attacks are not combined with nausea and vomiting.
6.The general analgesic drugs are completely ineffective for this disease.
7.The course of the disease is long. Episodes of severe pain can last for many years, and in some patients, the duration of the disease can be as long as decades. A small number of patients can have a large interval, which can be months or years without attacks. Others may have episodes of lightness after ten years or decades, and the pain will stop in old age.
8, not combined with loss of sensation in the head and face, muscle paralysis or other symptoms of cerebral nerve paralysis, such as diplopia, facial palsy, etc.. Individual patients have hyperalgesia or hypersensitivity to pain on the affected side, or weak chewing power.
The diagnostic criteria for primary trigeminal neuralgia as determined by the Classification Committee of the International Society for Head and Facial Pain are
1. paroxysmal episodes of facial pain lasting several seconds.
2. The pain contains at least four of the following criteria.
①The pain is limited to one or more branches of the trigeminal nerve distribution area;
② Pain is sudden, intense, sharp, stabbing or burning pain on the skin surface;
③The pain is severe;
④Stimulation of the trigger point can induce pain;
⑤ with intermittent spasm attacks.
3.No neurological damage.
4.The form of each seizure is stereotyped.
5.Exclude other disorders that cause facial pain.
For patients suspected of secondary trigeminal neuralgia, detailed physical examination should be performed, and cranial plain film, CT and/or MRI examination should be performed if necessary.