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The common symptoms of trigeminal neuralgia type 1: the pain is described by most patients as this sharp pain. Some patients describe it like an ice pick behind the eye or a lightning bolt or a flash of pain. It usually affects the forehead, the cheek, or the jaw with the most common area being either the cheek region or the jaw region or something in between. It truly is like a flash of pain which lasts either seconds, maybe a few minutes, but rarely longer than that.
The common symptoms of trigeminal neuralgia type 1: the pain is described by most patients as this sharp pain. Some patients describe it like an ice pick behind the eye or a lightning bolt or a flash of pain. It usually affects the forehead, the cheek, or the jaw with the most common area being either the cheek region or the jaw region or something in between. It truly is like a flash of pain which lasts either seconds, maybe a few minutes, but rarely longer than that.
One of the hallmarks of trigeminal neuralgia type 1 is that it can be triggered by something. So patients very, very quickly learn that these episodes of shock-like pain that they're experiencing on their face are sometimes randomly occurring, but there are a certain number of things that they can often do that reliably will cause the pain to occur. They very, very quickly learn what those are. Some of the more common ones are: touching the face, showering, chewing, for some patients talking. One of the peculiar ones is cold air. Cold air on the face is a very common trigger, so these sorts of triggers are one of the important things that a physician will look for when listening to some patient with presumed trigeminal neuralgia because the doctor is going to want to hear that there are triggers that set this off. If there are no triggers whatsoever, it doesn't mean that you can't have trigeminal neuralgia, but it does put the diagnosis not into doubt, but it does put a little bit of a question mark and the doctor's going to want to explore more things and get more history.
We don't really know what causes trigeminal neuralgia type 1. We have some clues about it, though. We know that nerves sort of transmit these signals and we know that nerves have this lining around them that insulates them so they don't cross-talk. We know that there's some sort of probable defect in that insulation and essentially these nerves short circuit and that's what produces the pain on somebodies face. It is really literally a short circuiting somewhere along the nervous pathway between the nerve as it leaves the brain and then goes to the face. The reason we have those clues is we know that somebody with a condition called multiple sclerosis where the insulation surrounding the nerve is lost, they have a much, much higher rate of trigeminal neuralgia type 1 than the general population. We also know that patients with some tumors that push up against this nerve (the trigeminal nerve) where we think the installation wears down, they also have a higher rate of this painful condition.Wwhile we don't know exactly what the heart of this, we do know that it's some sort of defect in the way the nerves transmit their electrical signal.
Although we don't fully understand why people get trigeminal neuralgia, we do have some clues. There is a theory called the microvascular compression theory, which really had a lot of support - probably a little bit less support now - but at one time, that was the best theory that explained so much of this disorder. In a nutshell what it was was that there's a nerve and we know that there's some sort of short circuiting going on in the nerve that leads to these episodes of pain. One of the things that we found at the time of surgery is that there's a blood vessel that seems to be lying over the nerve. We found that by separating the blood vessel from the underlying nerve, that trigeminal neuralgia (in most cases) we could cure it. This theory came about called the microvascular compression theory of trigeminal neuralgia where we felt that a pulsating vessel up against the nerve led to loss of insulation on the nerve and then therefore the short circuiting and therefore then the pain syndrome. That was commonly held for years - if not decades. The problem we find in this theory is that there are some times when we will do surgery and we won't find any blood vessel at all. Yet we do the same maneuver where we stroke the nerve or we touch the nerve and people still get cured of their trigeminal neuralgia and so some elements of that theory are being put into question. My own personal opinion is that there's probably some genetic aberration or genetic abnormality in these patients where the insulation isn't being formed correctly and that's probably at the heart of it. But it's important to know this theory because that's the underpinning of the surgery that we do to treat this disorder.
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