A detailed description of “facial pain”

  Trigeminal neuralgia (also known as “facial pain”), in many patients, the pain is preferred in the face and teeth, so it is easily confused with toothache, and the teeth are mistakenly extracted, but the pain still does not improve. However, there is a big difference between the two. Generally, toothache is characterized by persistent dull pain or throbbing pain, confined to the gum area, not radiating to other parts of the face, no facial skin irritation area, not aggravated by external factors, but the patient is afraid to chew with teeth, and the application of X-ray or CT examination can clarify toothache. Trigeminal neuralgia is a kind of recurrent paroxysmal severe neuralgia occurring in the distribution area of the facial trigeminal nerve, often manifested as a sudden onset of p brief but intense lightning-like pain, which is often described by patients as electric burning-like, pinprick-like, knife-like or tearing-like severe throbbing pain. The patient often presses the affected side of the face with the palm of the hand or a towel during the attack, or rubs the face vigorously to relieve the pain. Some patients keep doing chewing action during the attack, and serious cases are accompanied by severe twitching of facial muscles, with the corners of the mouth pulled to one side, also known as “painful twitching”. Sometimes it is accompanied by facial redness, increased skin temperature, congestion of the conjunctiva, lacrimation, increased salivation, congestion of the nasal mucosa, and runny nose.   Each attack of trigeminal neuralgia can last from a few seconds to a few minutes, and can stop abruptly, and everything is mostly normal during the interval of pain. Generally, the attacks are milder or stop at night, but in severe cases, the attacks can be frequent overnight and cannot sleep or wake up with pain after sleep. Trigeminal neuralgia may gradually worsen and the attacks may become more frequent, even once every few minutes, and may last all day long. The pain may come on periodically, with each attack lasting several weeks or months, and remission periods varying from days to years. The periodicity of attacks is climate-related, with spring and winter being more likely.  Some parts of the face, such as the upper and lower lips, nose, corners of the mouth, cheeks, teeth, and tongue, can cause painful episodes with the slightest touch, and these sensitive areas are called “trigger points”. Patients with trigeminal neuralgia often have a normal neurological examination, but CT and MRI can sometimes indicate the presence of intracerebral tumors.  The main characteristics of the disease are as follows: gender and age: most of the patients are over 40 years old, with more middle-aged and elderly people, and more women than men.  Pain site: more on the right side than on the left side. The pain starts from a point in the face, mouth or jaw and spreads to one or more branches of the trigeminal nerve, with the second and third branches being the most common, and the first branch is rare.  Presence of trigger points: There are particularly sensitive trigger points in the distribution area of the trigeminal nerve on the affected side, such as the lateral part of the upper and lower lips, the nose, incisors, tongue and cheeks, etc., which can cause a painful attack with a slight touch.  Nature of pain: such as cutting, stabbing, tearing, burning or electric shock-like pain, or even unbearable pain.  Triggering factors: The pain attack can be triggered by talking, eating, washing face, brushing teeth and wind blowing, so that the patient is depressed, acts cautiously, and even dares not wash face, brush teeth, eat, and speak carefully for fear of pain attack.  Pain pattern: Each pain attack lasts from a few seconds to 1 to 2 minutes and stops abruptly. At the beginning of the disease, the number of episodes