Pinched nerve in nose: The request could not be satisfied

21.02.198005.12.2021 by alexxlab

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Empty nose syndrome – Caring Medical Florida

Ross Hauser, MD

I am going to start this article surrounding research and treatments of Empty nose syndrome with a patient’s story here at the Hauser Neck Center at Caring Medical. Then we will discuss how Empty nose syndrome remains a medical enigma and describe possible paths of treatments.

In this case history below, I will describe an initial teleconference I had with a patient. It will show that Empty nose syndrome is not a disorder that sits in isolation, but rather a problem that is one of many conditions many of the people we see at our center suffer from. Empty nose syndrome can be caused by many problems. In this article, I will present one possible answer.

The acrobat is grounded: His symptoms had become overwhelming and too much for him to realistically handle as a high-flying acrobat.

A well-known acrobatic master contacted us at Caring Medical because he suffered from many different “neurologic-type” symptoms, had received many different diagnoses, had many treatments, procedures, and tests, and was finally diagnosed with Empty nose syndrome amongst his other problems. He contacted us because he felt his symptoms were related to atlantoaxial instability, vagus nerve compression, and cerebrospinal venous insufficiency.

To perform the acrobatic tricks and stunts he does, our patient needs to master his skills through demanding and repetitive practice. He reported to us that he could no longer practice his routines and without the confidence and precision needed to perform at a master’s level, our patient had to ground himself.

Symptoms, conditions, and medical history

The patient suffered from shortness of breath (dyspnea) and an inability to feel the air going through his nose. He cannot breathe at times and constantly feels like he is drowning in nasal and sinus fluids. Then he begins to hyperventilate.

He was always a nose breather until the symptoms started. He has always been in master’s level/elite athletic shape and now he is practically bed-bound.

To relieve his shortness of breath and to assist his nose breathing, he has visited numerous ENTs, pulmonologists, and other specialists who have prescribed a myriad of tests and treatments including various sprays, steroids, and medications, all to no avail. He sought out alternative medicine healers who have been unable to help.

The various tests he has had, including endoscopy, MRIs, blood gas analysis, x-rays, and many others, have not been helpful in figuring out what is causing his shortness of breath and inability to breathe out of his nose.

Other symptoms include:

loss of his sense of smell,
disconnected feeling (head disconnected from rest of body),
chronic head pressure,
facial redness with changes of neck movement,
lightheadedness and dizziness,
stomach bloating,
constant hiccups,
reflux,
swallowing difficulty, the sensation of food caught in his throat,
inability to talk for very long,
chest pressure,
excessive saliva,
tinnitus,
hearing loss when looking left, ear fullness,
insomnia.

It IS in his nose, BUT, it is coming from his neck?

This is just a partial list. So here we have a patient whose main complaint is the problem of being able to breathe through his nose, yet he suffers from all these other conditions. How do we treat a patient like this? Is his inability to breathe through his nose causing oxygen to shut off? His inability to breathe through his nose causing all these other problems? Is it all in his nose? In this one case we suggest, it IS in his nose, BUT, it is coming from his neck?

First, let’s explore some of the supportive research which may guide us in understanding that for many people, these symptoms including Empty Nose Syndrome can find their cause and origin in the cervical spine and neck instability causing compression on the arteries, veins, and nerves that make their way in and around the cervical spine vertebrae.

Making a connection with the trigeminal nerve

An August 2019 study in the journal Current Opinion in Otolaryngology and Head and Neck Surgery (1) comes to us from the Department of Otolaryngology-Head and Neck Surgery, University of California Davis. Here are the points:

“Historically, Empty nose syndrome has been associated with a reduction in nasal turbinate size; new data suggest that impaired trigeminal nerve function may also play a role in the pathophysiology of the disease.”

Note: Nasal turbinate size: The nasal turbinates are mucus-covered boney structures inside the nose. They regulate airflow in and out of the nose and help warm the air you breathe in. The nasal turbinates can fluctuate in size in response to illness, allergies, and sensitivities and cause a “stuffy nose.” In many patients we see, chronic sinusitis and problems with the nasal turbinates are frequent complaints.

Clearly, someone with problems breathing in and out of their nose, where the diagnosis may be confused or hard to find may eventually wind up in a discussion about the dysfunction of the nasal turbinates.

Impaired trigeminal nerve function

Demonstration of trigeminal nerve dysfunction would be a big clue in following a path that this patient’s problems with Empty nose syndrome were being caused by nerve compression from cervical spine instability. We have two very detailed articles on our website concerning Trigeminal neuralgia: The evidence for Trigeminal Neuralgia non-surgical treatments, and, Cluster headache treatment – cervical ligament instability and the trigeminal and vagus nerves. I am going to summarize them here in regard to Empty nose syndrome.

In our many years of helping people with chronic pain of the head, neck, jaw, and face we have seen many people with a diagnosis of Trigeminal neuralgia. For some of these people, possibly including yourself, it was not easy getting this diagnosis as this problem can be confusing and frustrating to understand. Not only for the patient but the doctor alike.

When a physician and a patient believe that this nerve is being compressed, it is easy to see why surgery would be recommended.

Trigeminal neuralgia centers on what is happening to the trigeminal nerve which carries pain, feeling, and sensation from the brain to the skin of the face. In the case of trigeminal neuralgia, most medical professionals cannot find the cause for why this pain started. This is borne out by the definition of trigeminal neuralgia. Trigeminal neuralgia means that there is nerve pain in the nerve distribution of the trigeminal nerve. It actually does not tell a person what is causing the condition.

Many people with trigeminal neuralgia initially believed they had a serious problem with their teeth. It could have started one day when they are brushing their teeth and suddenly they had shooting pain in their face/mouth.

Other related causes

Trigeminal Neuralgia can also be caused by simple daily acts.

Washing your face, shaving, the application of makeup.
Chewing food
Talking
Blowing your nose

Why do we examining the neck of a patient who comes in for a Trigeminal Neuralgia consultation?

The keyword is compression. The head and neck, as all parts of the body, live in complex relation. Something in the neck can cause problems in the jaw, face, and nose, etc.

At this point, we are going to quickly jump over to a 2017 paper that was published in the journal Laryngoscope (2). The title of this paper? “Intranasal trigeminal function in patients with empty nose syndrome.” Here are the learning points:

The trigeminal nerve mediates the perception of nasal airflow. This study examines whether the impaired intranasal trigeminal function is a part of the paradoxical nasal obstruction sensation in patients with empty nose syndrome (ENS).

Note: Understand that the researchers are exploring that an inability to breathe is a messenger “nerve” problem. The possibility that trigeminal function is being impaired by bad messages. Where are these bad messages coming from? Let’s see if we can find out.

Three groups of patients were examined:
- 1) Empty nose syndrome patients with previous bilateral near-total inferior turbinectomy. NOTE: Remember we discussed above what the nasal turbinates do. A Turbinectomy is a procedure where surgeons will remove some or all of the turbinate bones in the nasal passage. The goal is to relieve nasal obstruction and make it easier to breathe through the nose.
- 2) patients who underwent near-total inferior turbinate removal without Empty nose syndrome symptoms, and
- 3) control participants.

Results:

Analyses revealed that Empty nose syndrome patients had significantly lower scores on trigeminal lateralization testing (a test to assess trigeminal function in response to nasal stimulation) than the total inferior turbinate removal group and controls.
The Empty nose syndrome group had also significantly lower scores in olfactory testing (the ability to identify odors) than controls.
This study demonstrates significantly impaired intranasal trigeminal function in Empty nose syndrome patients.

Simply: It is a nerve compression problem. Where are the bad messages coming from? The trigeminal nerve. How? Compression of the trigeminal nerve somewhere along the line is sending out bad messages because of “compression interference.”

Mental Health Disorders

Up until this point of this article, the focus has been on the physical structure of the neck as a cause for the physical problems related to Empty Nose Syndrome. Now let’s briefly examine the mental aspects.

An October 2021 paper in the Otolaryngology–head and neck surgery (3) noted these issue in Empty Nose Syndrome patients

ENS patients demonstrated high symptom severity.
There is evidence of high comorbid mental health disorders in Empty Nose Syndrome patients.

Dysfunction of the Trigeminal Nerve

Ross Hauser, MD, and Brian Hutcheson, DC discuss Trigeminal Neuralgia or dysfunction and the strange sensations through the face, throat, nose, and ear.

Trigeminal neuralgia (nerve pain) can be caused by neck problems that lead to instability in the cervical spine, causing irritation of the trigeminal nerve.
When you have this trigeminal nerve irritation you can get, for lack of a better word, weird swishing, a “creepy-crawlies” sensation in the face, burning in the throat, burning in the inner ear, problems with sinus and ear drainage, and the problems of Empty Nose Syndrome.

The connection of the trigeminal nerve to the cervical spine

As described above, people with Empty Nose Syndrome can suffer from many conditions simultaneously.

There are connections between the upper cervical spine and the trigeminal nerve. There is an afferent or a stimulus that comes in from your upper neck. If you have cervical spine instability if you have a terrible problem with loss of the natural curve of the neck. If you have a descending of your brainstem, anything that is a dysfunction can cause a “bad signaling” to come out of the trigeminal nerve.

This bad signaling can cause:
- Pain in the face.
- Numbness in your face.
- Burning ears.
- Burning in the mouth.
- Watering of the eyes.
- Problems in the nasal and sinus cavities.

Why many treatments do not work

If we are pursuing cervical spine instability as the primary cause of the problems related to Empty nose syndrome, it is easy to see why treating many of the symptoms of this disorder are prone to failure and then surgery that may not address the true cause of the problem would be recommended.

Many patients we see with nasal breathing dysfunction often report that they have tried all the standard of care symptom alleviate treatments with limited success. These would include:

An abundance of saline nasal spray use. Then use of antibiotic nasal sprays and irrigations because the abundance of saline usage is causing nasal infections.
Use of humidifiers.
Use of CPAP machines.
Change in diet to favor hot foods and liquids.

The problems of cervical spine instability are usually not discussed.

Nasal inflammation /Rhinosinusitis / Sinusitis – is this a drainage problem caused by herniated discs?

In my article: Neck Pain and Cervical Spine Instability-Induced Chronic Sinusitis and Eustachian Tube Dysfunction, I discuss the problems of nasal inflammation. I will summarize and explain the connection here:

Malalignment of C1-C2 can impact sinus drainage

We have many articles and research studies that point out the possible problems misalignment of the C1-C2 or Atlantoaxial instability can cause. As I have also pointed out, the clue to a patient’s problems may lie in the fact that they suffer from many symptoms simultaneously and not from one or two isolated symptoms.

In the story of the patient that we are covering in this article, we see that he had many symptoms. People we see with Atlantoaxial instability can also suffer from drainage problems of the sinus and associated nasal congestion, headaches, hearing problems and ear infections, vision problems, balance, vertigo, dizziness, and nausea among many symptoms. Often they suffer all at once.

When the cervical spine is involved in nasal breathing problems, we suspect that the patient is having a drainage problem. The ear and sinus are not draining. One reason that they are not draining can be a bulging or herniated disc impinging on the cervical nerves in the C1-C2 region.

The start of the chase for the root cause of the problem. The connection between the vagus nerve and the trigeminal nerve and nasal problems

The vagus nerve, as illustrated below, travels through the cervical spine. It travels especially close to the C1, C2, C3 vertebrae. Cervical spine instability in these regions can cause herniation or pinching of the vagus nerve, which can lead to a disruption of normal nerve communication between the vagus nerve and the trigeminal nerve and trigeminal ganglion. This disruption or herniation of the nerve can cause among the many symptoms I have listed in this article.

What are we seeing in this image?

The vagus nerve, as illustrated here, travels through the cervical spine. It travels especially close to the C1, C2, C3 vertebrae. Cervical spine instability in these regions can cause herniation or pinching of the vagus nerve, which can lead to a disruption of normal nerve communication between the vagus nerve and the trigeminal nerve and trigeminal ganglia. This disruption or herniation of the nerve can cause among the many symptoms of nasal inflammation.

Our bodies have a left side trigeminal nerve and a right side trigeminal nerve. The trigeminal nerve separates into three branches. The ophthalmic (V1), maxillary (V2), and mandibular (V3) nerves.

In regard to the sinus:

The ophthalmic nerve (V1) serves the eye and parts of the nasal cavity. Damage or dysfunction of this nerve can impact sinus function and vision. This is why people have these symptoms concurrently. This could include sinusitis. Sinusitis can occur when the nerve messages are getting distorted and signals for proper drainage of the sinus are not getting through.
The maxillary nerve (V2) also serves parts of the nasal cavity and sinus as well as portions of the mouth. This is why sinus congestion and sinusitis can be reported by patients along with problems of the palate
The Vagus nerve serves the sinuses, the back of the throat (pharynx), and the larynx.

Restoring the natural curve of the spine and strengthening cervical spine ligaments – a possible treatment for Empty nose syndrome

Many patients we see when they come in for their first visit for issues of chronic pain and neurological symptoms, come in with an understanding that something is wrong with the curve of their neck and spine. This they learned through the many years of seeking treatments. This is why they also understand that the curvature of the spine is a complex problem.

In the story of our patient in this article, we noted that he had a military curve. A loss of the natural cervical spine curve.

The curvatures of the neck

What are we seeing in this image?

In our practice, we see problems of cervical spine instability caused by damaged or weakened cervical spine ligaments. With ligament weakness or laxity, the cervical vertebrae move out of place and progress into problems of chronic pain and neurological symptoms by distorting the natural curve of the spine. This illustration demonstrates the progression from Lordotic to Military to Kyphotic to “S” shape curve.

Repairing the ligaments and curve for a long-term fix

The goal of our treatment is to repair and strengthen the cervical ligaments and get your head back in alignment with the shoulders in a normal posture.

What are we seeing in this image?

In this illustration, we see the before and after of neck curve corrections. Ligament laxity or looseness or damage, whether the cause is from trauma, genetic as in cases of Ehlers-Danlos syndrome, ultimately causes a kyphotic force on the cervical spine, stretching the posterior ligament complex of the neck. As can be seen in the x-rays of this image, patients with a whiplash injury, Joint Hypermobility Syndrome, and Ehlers-Danlos syndrome can have their cervical curve restored with Prolotherapy Injections and the use of head and chest weights.

Treating Cervical Instability-Induced Empty nose syndrome with Cervical Curve Correction and Prolotherapy

Prolotherapy is an injection technique that stimulates the repair of unstable, torn or damaged ligaments. When the cervical ligaments are unstable, they allow for excessive movement of the vertebrae, which can stress tendons, atrophy muscles, pinch on nerves, such as the vagus nerve, and cause other symptoms associated with cervical instability including problems of digestion among others.

In 2014, we published a comprehensive review of the problems related to weakened damaged cervical neck ligaments in The Open Orthopaedics Journal. (3) We are honored that this research has been used in at least 6 other medical research papers by different authors exploring our treatments and findings and cited, according to Google Scholar, in more than 40 articles.

In our clinical and research observations, we have documented that Prolotherapy can offer answers for sufferers of cervical instability, as it treats the problem at its source. Prolotherapy to the various structures of the neck eliminates the instability and the sympathetic symptoms without many of the short-term and long-term risks of cervical fusion. We concluded that in many cases of chronic neck pain, the cause may be underlying joint instability and capsular ligament laxity. Furthermore, we contend that the use of Comprehensive Prolotherapy appears to be an effective treatment for chronic neck pain and cervical instability, especially when due to ligament laxity. The technique is safe and relatively non-invasive as well as efficacious in relieving chronic neck pain and its associated symptoms.

In this video, DMX displays Prolotherapy before and after treatments

In this video, we are using a Digital Motion X-Ray (DMX) to illustrate a complete resolution of a pinched nerve in the neck and accompanying symptoms of cervical radiculopathy.
A before digital motion x-ray at 0:11
At 0:18 the DMX reveals completely closed neural foramina and a partially closed neural foramina
At 0:34 DXM three months later after this patient had received two Prolotherapy treatments
At 0:46 the previously completely closed neural foramina are now opening more, releasing pressure on the nerve
At 1:00 another DMX two months later and after this patient had received four Prolotherapy treatments
At 1:14 the previously completely closed neural foramina are now opening normally during motion

Summary and contact us. Can we help you? How do I know if I’m a good candidate?

We hope you found this article informative and it helped answer many of the questions you may have surrounding Empty Nose Syndrome. Just like you, we want to make sure you are a good fit for our clinic prior to accepting your case. While our mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a multi-step process so our team can really get to know you and your case to ensure that it sounds like you are a good fit for the unique testing and treatments that we offer here.

Please visit the Hauser Neck Center Patient Candidate Form

References for this article:

1 Gill AS, Said M, Tollefson TT, Steele TO. Update on empty nose syndrome: disease mechanisms, diagnostic tools, and treatment strategies. Current opinion in otolaryngology & head and neck surgery. 2019 Aug 1;27(4):237-42. [Google Scholar]
2 Konstantinidis I, Tsakiropoulou E, Chatziavramidis A, Ikonomidis C, Markou K. Intranasal trigeminal function in patients with empty nose syndrome. The Laryngoscope. 2017 Jun;127(6):1263-7. [Google Scholar]
3 Kanjanawasee D, Campbell RG, Rimmer J, Alvarado R, Kanjanaumporn J, Snidvongs K, Kalish L, Harvey RJ, Sacks R. Empty Nose Syndrome Pathophysiology: A Systematic Review. Otolaryngology–Head and Neck Surgery. 2021 Oct 19:01945998211052919. [Google Scholar]
4 Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. The open orthopaedics journal. 2014;8:326. [Google Scholar]

This article was update 11/15/2021

Trigeminal Neuralgia | Cedars-Sinai

Not what you’re looking for?

Overview

Trigeminal neuralgia (tic douloureux) is a disorder of a nerve at the side of the head, called the trigeminal nerve. This condition causes intense, stabbing or electric shock-like pain in the lips, eyes, nose, scalp, forehead and jaw. Although trigeminal neuralgia is not fatal, it is extremely painful.

Symptoms

The main symptom of trigeminal neuralgia is a sudden attack of pain (often described as intense, shooting, stabbing or electrical shock-like) that lasts anywhere from seconds to two minutes. Sometimes the pain hits without warning, while other times even mild stimulation of the face from ordinary activities (such as smiling, brushing teeth, eating, drinking, applying makeup, combing or brushing hair, shaving or touching the skin) can trigger a pain attack. At first the attacks may be short and relatively mild, but over time they last longer, are more painful and happen more often.

The trigeminal nerve has three branches in the face, each of which controls a different part of the face, and any or all branches of the nerve may be affected. The pain typically involves only one side of the face. It can affect the upper, middle or lower portions of the face or all of them. The pain never crosses over to the other side of the face. In rare cases, trigeminal neuralgia is felt on both sides of the face, but the right side pain is separate and distinct from the left side pain.

When experiencing an attack of trigeminal neuralgia, individuals will almost always want to be still and avoid talking or moving the face. The pain may cause the face to contort into a painful wince. Attacks of trigeminal neuralgia rarely occur while sleeping.

During certain periods, the attacks of pain may be worse or more frequent. Individuals may also have extended times with no pain (remission). One of the challenges of trigeminal neuralgia is the inability to predict when the next flare-up may happen. Especially severe flare-ups may produce so many pain attacks that the pain feels nearly constant. In severe or long-term cases of trigeminal neuralgia, an aching pain or light numbness may develop in the affected area of the face.

Causes and Risk Factors

The pain of trigeminal neuralgia is usually caused by pressure on the trigeminal nerve at the base of the brain. The pressure can be result from:

A stroke that affects the lower part of the brain, where the trigeminal nerve enters
A tumor that pushes on the nerve
Contact between a normal artery or vein and the trigeminal nerve (the most common cause of trigeminal neuralgia)
Injury to the nerve (such as from a car accident or head trauma)
Surgery on the teeth and gums or the sinuses can also cause injury to the trigeminal nerve
Multiple sclerosis, which causes damage to the nerves and can affect the trigeminal nerve

This condition occurs most often after the age of 50, although it has been found in children and infants. Women are nearly twice as likely to develop trigeminal neuralgia as men are.

Diagnosis

Trigeminal neuralgia is not easy to diagnose. Neurologic tests and physical examination of the skull and face usually reveal no abnormality. A person experiencing unexplained facial pain may be mistakenly diagnosed as having a dental condition, disorders of the hinge of the jaw (temporomandibular joint), sinus infections, eye conditions, migraines, temporal arteritis or even psychologic disorders. Any doctor or dentist who sees patients with facial, gum or jaw pain should be alert to the possibility that the condition is trigeminal neuralgia.

Usually a diagnosis is based on the description of the pain and related features. The doctor must also eliminate the possibility of other conditions that also may cause facial pain. If the pain is relieved by treatment for trigeminal neuralgia, the diagnosis of the condition is usually confirmed. No known clinical or laboratory tests or X-rays can confirm trigeminal neuralgia. It may be necessary to order an MRI which, in some cases, can help identify the vessel pressing on the nerve.

Treatment

The first treatment for trigeminal neuralgia is usually drug therapy. Certain medications can help lessen or block pain. Additionally, drugs that are designed to control convulsions or seizures or some anti-depressant drugs can be helpful in relieving pain. Drugs that may be prescribed include:

Baclofen (Lioresal)
Carbamazepine (Tegretol or Carbatrol)
Clonazepam
Gabapentin
Oxcarbazepine (Trileptal)
Phenytoin (Dilantin or Phenytek)
Pregabalin (Lyrica)
Topiramate (Topamax)
Valproic acid

If drugs fail to control the pain or if they produce undesirable side effects, neurosurgery may be needed. A variety of surgical techniques are available to treat trigeminal neuralgia. The goal of many of these procedures is to damage or destroy part of the trigeminal nerve that is causing the pain. This can lead to numbness in the face to a varying degree. Some of the surgical options are:

Injecting alcohol or glycerol near different portions of the trigeminal nerve to either numb it or damage the nerve and block the pain signals that it has been sending
Injecting a tiny balloon through a thin, flexible tube (a catheter) until it reaches the trigeminal nerve. Once there, the balloon is inflated with enough pressure to damage the nerve and block pain signals.
Sending an electric current into the root of the trigeminal nerve to damage nerve fibers and help control pain. This procedure is called percutaneous stereotactic radiofrequency thermal rhizotomy (PSRTR).
Microvascular decompression (MVD), which relocates or removes blood vessels that are in contact with the trigeminal nerve and separates the nerve and the blood vessels with a small pad. Doctors at the Maxine Dunitz Neurosurgical Institute’s Trigeminal Neuralgia Program perform this surgery endoscopically, which does not damage the nerve and is less likely to cause side effects (such as numbness).
Severing the nerve in a procedure called partial sensory rhizotomy (PSR). While this process is helpful, it almost always causes numbness in the face.
Radiosurgery to damage the nerve and reduce or eliminate the pain. This technique involves sending a focused, intense dose of radiation to the root of the trigeminal nerve. Relief may take several weeks to begin. The procedure is painless and is usually done without anesthesia.

At Cedars-Sinai, treatment of trigeminal neuralgia uses a multidisciplinary approach that brings together neurosurgeons, specialists in pain management, psychologists, a social worker and pharmacologists to devise a customized approach to treating trigeminal neuralgia. Each of these specialists collaborates closely to provide the most appropriate care.

Not what you’re looking for?

Facial Problems, Noninjury | Michigan Medicine

Do you have a facial problem?

How old are you?

Less than 4 years

4 years or older

Are you male or female?

Why do we ask this question?

If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
If your symptoms aren’t related to those organs, you can choose the gender you identify with.
If you have some organs of both sexes, you may need to go through this triage tool twice (once as “male” and once as “female”). This will make sure that the tool asks the right questions for you.

Have you had a head injury in the past 24 hours?

Yes

Head injury in past 24 hours

Have you had an injury to your face in the past 2 weeks?

Yes

Facial injury in the past 2 weeks

Are you having trouble breathing (more than a stuffy nose)?

Yes

Difficulty breathing more than a stuffy nose

Could you be having a severe allergic reaction?

This is more likely if you have had a bad reaction to something in the past.

Yes

Possible severe allergic reaction (anaphylaxis)

Could you be having symptoms of a heart attack?

In some cases, a heart attack may cause a strange feeling in part of the face, such as the jaw.

Yes

Symptoms of heart attack

Have you had any new vision changes?

These could include vision loss, double vision, or new trouble seeing clearly.

Did you have a sudden loss of vision?

A loss of vision means that you cannot see out of the eye or out of some part of the eye. The vision in that area is gone.

Do you still have vision loss?

Yes

Vision loss still present

Did the vision loss occur within the past day?

Yes

Vision loss occurred in the past day

Have you had any changes in feeling or movement in your face?

Changes could include weakness or loss of movement in part of the face, numbness or tingling, facial drooping, or trouble closing an eye.

Yes

Changes in feeling or movement in face

Do you have blisters on your forehead, eyelid, or nose?

Blisters in this area may be a sign of shingles and may cause serious eye problems.

Is there any swelling in your face?

Was the swelling sudden?

Yes

Facial swelling was sudden

Do you think the eyelid or the skin around the eye may be infected?

Symptoms could include redness, pus, increasing pain, or a lot of swelling. (A small bump or pimple on the eyelid, called a stye, usually is not a problem.) You might also have a fever.

Yes

Symptoms of infection around eye

Do you have any pain in your face?

Do you have any eye pain?

Have you had facial pain for:

Less than 1 full day (24 hours)?

Pain for less than 24 hours

1 day to 1 week?

Pain for 1 day to 1 week

More than 1 week?

Pain for more than 1 week

Do you think you may have a fever?

Are there red streaks leading away from the area or pus draining from it?

Do you have diabetes, a weakened immune system, or any surgical hardware in the area?

“Hardware” in the facial area includes things like cochlear implants or any plates under the skin, such as those used if the bones in the face are broken.

Yes

Diabetes, immune problems, or surgical hardware in affected area

Have you had thick, yellow discharge from your nose for more than 5 days that is not getting better?

This may mean you have a sinus infection.

Yes

Nasal discharge more than 5 days not getting better

Do you have a rash or any blisters on your face?

Yes

Rash or blisters on face

Do you think that a medicine may be causing the facial problem?

Think about whether the symptoms started soon after you began using a new medicine or a higher dose of a medicine.

Yes

Medicine may be causing facial symptoms

Have your symptoms lasted longer than 1 week?

Yes

Symptoms have lasted longer than 1 week

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

Your age. Babies and older adults tend to get sicker quicker.
Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

Try home treatment to relieve the symptoms.
Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Symptoms of difficulty breathing can range from mild to severe. For example:

You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).
It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you’re at rest (severe difficulty breathing).

Severe trouble breathing means:

You cannot talk at all.
You have to work very hard to breathe.
You feel like you can’t get enough air.
You do not feel alert or cannot think clearly.

Moderate trouble breathing means:

It’s hard to talk in full sentences.
It’s hard to breathe with activity.

Mild trouble breathing means:

You feel a little out of breath but can still talk.
It’s becoming hard to breathe with activity.

Severe trouble breathing means:

The child cannot eat or talk because he or she is breathing so hard.
The child’s nostrils are flaring and the belly is moving in and out with every breath.
The child seems to be tiring out.
The child seems very sleepy or confused.

Moderate trouble breathing means:

The child is breathing a lot faster than usual.
The child has to take breaks from eating or talking to breathe.
The nostrils flare or the belly moves in and out at times when the child breathes.

Mild trouble breathing means:

The child is breathing a little faster than usual.
The child seems a little out of breath but can still eat or talk.

Pain in adults and older children

Severe pain (8 to 10): The pain is so bad that you can’t stand it for more than a few hours, can’t sleep, and can’t do anything else except focus on the pain.
Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it’s severe when it’s there.
Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.

Symptoms of infection may include:

Increased pain, swelling, warmth, or redness in or around the area.
Red streaks leading from the area.
Pus draining from the area.
A fever.

Symptoms of a severe allergic reaction (anaphylaxis) may include:

The sudden appearance of raised, red areas (hives) all over the body.
Rapid swelling of the throat, mouth, or tongue.
Trouble breathing.
Passing out (losing consciousness). Or you may feel very lightheaded or suddenly feel weak, confused, or restless.

A severe reaction can be life-threatening. If you have had a bad allergic reaction to a substance before and are exposed to it again, treat any symptoms as an emergency. Even if the symptoms are mild at first, they may quickly become very severe.

Symptoms of a stroke may include:

Sudden numbness, tingling, weakness, or paralysis in your face, arm, or leg, especially on only one side of your body.
Sudden vision changes.
Sudden trouble speaking.
Sudden confusion or trouble understanding simple statements.
Sudden problems with walking or balance.
A sudden, severe headache that is different from past headaches.

Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.

Adults and older children often have several symptoms of shock. These include:

Passing out (losing consciousness).
Feeling very dizzy or lightheaded, like you may pass out.
Feeling very weak or having trouble standing.
Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.

Shock is a life-threatening condition that may occur quickly after a sudden illness or injury.

Babies and young children often have several symptoms of shock. These include:

Passing out (losing consciousness).
Being very sleepy or hard to wake up.
Not responding when being touched or talked to.
Breathing much faster than usual.
Acting confused. The child may not know where he or she is.

Certain health conditions and medicines weaken the immune system’s ability to fight off infection and illness. Some examples in adults are:

Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
Long-term alcohol and drug problems.
Steroid medicines, which may be used to treat a variety of conditions.
Chemotherapy and radiation therapy for cancer.
Other medicines used to treat autoimmune disease.
Medicines taken after organ transplant.
Not having a spleen.

Symptoms of a heart attack may include:

Chest pain or pressure, or a strange feeling in the chest.
Sweating.
Shortness of breath.
Nausea or vomiting.
Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
Lightheadedness or sudden weakness.
A fast or irregular heartbeat.

For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms, like shortness of breath, nausea, and back or jaw pain.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

Call your doctor today to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don’t have one, seek care today.
If it is evening, watch the symptoms and seek care in the morning.
If the symptoms get worse, seek care sooner.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

Call your doctor now to discuss the symptoms and arrange for care.
If you cannot reach your doctor or you don’t have one, seek care in the next hour.
You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

Make an appointment to see your doctor in the next 1 to 2 weeks.
If appropriate, try home treatment while you are waiting for the appointment.
If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

After you call 911, the operator may tell you to chew 1 adult-strength (325 mg) or 2 to 4 low-dose (81 mg) aspirin. Wait for an ambulance. Do not try to drive yourself.

Facial Injuries

Head Injury, Age 4 and Older

Head Injury, Age 3 and Younger

Atypical Facial Neuralgias

Persistent burning or lancinating facial pain with no clear etiology may point to a diagnosis of neuropathic pain.

Neuralgias are syndromes characterized by intermittent attacks of sharp and paroxysmal pain along the course of a nerve. The neuralgias involving the face are often misdiagnosed and seen initially by the dentist or otolaryngologist. Therefore treatment is often delayed and patients may unnecessarily suffer from neuropathic pain until someone correctly recognizes the signs and refers the patient to a neurologist. The authors describe some of the atypical and lesser-known neuralgias of the face.

Occipital Neuralgia

Neuropathic pain originating in the back of the head along the distribution of the occipital nerves is called occipital neuralgia (see Figure 1). The greater occipital nerve, which originates from the posterior root of the second cervical nerve in the neck, is the most common nerve to be involved. The lesser occipital nerve, arising from the posterior branch of the third spinal nerve in the cervical spine and situated behind the mastoid, is less commonly affected.

Etiology

Occipital neuralgia is most commonly idiopathic in that no causative factor can be identified. It can sometimes be secondary to injury to the nerve (e.g. direct trauma to the occipital nerves from a whiplash hyperextension injuries), compression of the nerve (between atlas and axis), or the upper cervical roots from arthritic changes in the spine (rheumatoid arthritis and ankylosing spondylitis).¹ Compression of the occipital nerve has been described along its course up the neck-while exiting from the semispinalis capitis or trapezius muscles-from everyday activities such as leaning against the back of a chair for an extended period of time. There are also rare occurrences where structural pathology like tumors involving the 2nd and 3rd cervical dorsal roots and sometimes developmental abnormalities can also be causative.

Symptoms and Signs

The pain associated with greater occipital neuralgia is intermittent, sharp, jabbing or throbbing and usually starts in the suboccipital region at the base of the skull near the midline, involves the entire posterior and lateral scalp, and usually radiates towards the vertex. Insult or injury to the lesser occipital nerve will cause pain around the mastoid process and radiate to areas near the ear and lower temple. Pressure on the suboccipital region over the occipital nerve will reproduce pain with radiation. Severe cases may actually have Tinel’s sign in which tapping on the area of the nerve causes sharp, throbbing pain and tingling. One may encounter extreme tenderness upon palpation over the occipital notches and upper cervical region with paroxysms of pain. On sensory exam, there may be hypesthesia or dysesthesia or paresthesia in the posterior scalp. Patients may also report spasms of the para vertebral muscles and restriction of neck movements.

Diagnosis

Diagnosis is mainly clinical and based on the localization of pain aligned with the distribution of the occipital nerves. An abnormal neuroexam should prompt imaging of the brain with MRI of cervical spine. The usual MRI sequences are not able to visualize the structural anatomy of the occipital nerves unless there is a gross abnormality like a large tumor.

Differential Diagnosis

Occipital neuralgia can present like migraine, with unilateral, throbbing pain especially when it radiates to the frontal, orbital and periorbital region.² Sometimes nausea, vomiting, photophobia or phonophobia, and eye changes may accompany occipital neuralgia and mimic a migraine. The situation is further complicated by the ability of occipital nerve blocks to relieve migraine headaches and the fact that both these disorders seem to coexist. One study showed that out of 500 patients suffering from migraine headache, almost 40% treated by occipital nerve block had relief of their migraine.

One way to distinguish the two is that typical acute treatment for migraine like the Triptans or ergot alkaloids will not work for occipital neuralgia. The explanation for this seemingly common overlap in presentation is based on neuroanatomical pathways. The C2, C3 nerves project to the nucleus caudalis of the trigeminal nerve, which as we now know, is a key player in generation of migraine headaches. Greater occipital neuralgia probably triggers the pain pathways arising from the nucleus caudalis and therefore can conceivably trigger a migraine attack. In a headache patient, examination should therefore include a thorough examination of the back of the head, and base of neck for tenderness along occipital nerves, apophyseal joints and mobility of the cervical spine.

Figure 1. Distribution of the occipital nerves. Figure 2. The glossopharyngeal nerve exits the skull through the jugular foramen behind the styloid process. Figure 3. Inflammation of the shenopalatine ganglion may affect sensory, motor, and autonomic functioning of the nose, mouth, and throat.

Treatment

The initial treatment is symptomatic with analgesics, muscle relaxants, soft cervical collar and physical therapy with gentle range of motion exercises especially head flexion. Local nerve blocking injections with steroids and local anesthetics can be very helpful for symptomatic relief of pain.³ It is hypothesized that depomedrol, a commonly used depot steroid agent for local nerve blocks causes demyelination of the nerve fibers and therefore provides relief of symptoms.

Surgical ablation procedures include sectioning either the peripheral nerve in the scalp or at the 2nd and 3rd cervical roots for medically intractable cases. Occipital nerve release has been attempted in one case series under the presumption that the nerve is commonly trapped while exiting either the trapezius or semispinalis muscle.⁴ Complete pain relief was not attained in any patient. The benefit from the surgery appeared short-lived and complications included denervation pain and neuroma formation along with recurrence or worsening of pain. Peripheral nerve electrostimulation is a relatively new modality of treatment where subcutaneous electrodes are placed on the occipital nerve which are then stimulated by a small distal generator placed superficially in the abdomen.⁵

Glossopharyngeal Neuralgia

This is a rare type of neuropathic pain originating from the 9th (glossopharyngeal) and sometimes also the 10th (Vagus) cranial nerves. It is therefore also called vagoglossopharyngeal neuralgia.⁶ The glossopharyngeal nerve exits from the skull through the jugular foramen, behind the styloid process, to supply the tongue and pharynx (see Figure2). It is responsible for sensory and motor supply to the pharynx, taste and general sensations from the back of the tongue, external ear and internal surface of the tympanic membrane, and salivation (supply to parotid gland). It also receives fibers from the carotid body and sinus and participates in the maintenance of blood pressure and sympathetic tone of blood vessels.

Etiology

It is usually idiopathic in nature. Secondary causes include nerve compression while exiting the neck by trauma, local infection or an elongated styloid process or tumors.⁷ Recent improvement in imaging techniques has resulted in better diagnosis of secondary causes of the neuralgia due to compression of the nerve root at its entry zone by an artery (vertebral or posterior inferior cerebellar artery) or vein and distortion by tumors like papillomas.

Symptoms and Signs

Typically patients have paroxysmal, lancinating pain on jaw movements, which radiate to areas innervated by the 9th nerve including external auditory canal and posterior oropharynx. These attacks of pain may be associated with syncope⁸, cardiac arrest, or even seizures, because of the close proximity of the glossopharyngeal nerve to the carotid body. Loss of taste at the base of tongue is sometimes reported. Neurological examination is usually entirely negative, but sometimes may show decreased oropharyngeal sensations, gag and cough reflex.

Diagnosis

Diagnosis is based on the clinical picture. Diagnosis and treatment of such patients is often delayed because they present first to otolaryngologist with vague symptoms of earache or a foreign body sensation inside the throat or tonsils. Referral to a neurologist is usually only initiated after multiple visits and a thorough workup, including direct and indirect visualization with laryngoscopy, to essentially exclude an ear, nose or throat problem. However, especially for intractable patients and patients willing to consider a surgical treatment option, MR Angiograms should be obtained to look for compression of the nerve by a blood vessel. MRI of brain with contrast can be non-diagnostic unless special thin cuts and sequences are obtained from the region of interest.

Treatment

Pharmacology is the first line in treatment and should include antiepileptics to control the neuropathic pain. Carbamazepine can be initiated at 200mg three times a day. Other antiepileptics can be added if maximizing the dose of carbamazepine is not effective and may include oxcarbemazepine, gabapentin or topiramate.

Surgical treatment is recommended for secondary pathology like tumor or for intractable neuropathic pain not responsive to medical treatment. Craniotomy of posterior fossa with transaction of 9th cranial nerve roots, which may later include the upper vagal nerve roots, may be initially attempted. Surgical techniques include either an intracranial section of the 9th and 10th cranial nerves or extra cranial section of 9th nerve. Recently there is increasing evidence that the nerve root may be compressed by a blood vessel and, if radiologic confirmation is present, then separating the nerve from the artery by teflon (a technique called microvascular decompression) is the treatment of choice. Sometimes mobilization of the vessel in contact with the nerves by gentle and direct manipulation of the nerve, without interspersing it with teflon, may result in relief of symptoms.

Complete, long-term pain-free relief has been reported in 60% patients in one large series.⁹ Complications of surgery included cranial nerve palsy and cerebrospinal fluid leak. Transient elevation of blood pressure after sectioning of the nerve has also been reported. There is some controversy regarding the micro vascular decompression. Over 50% of normal asymptomatic individuals may have an artery or vein in close proximity to the nerve roots. In patients with glossopharyngeal neuralgia, preoperative angiograms may not show the tortuous vessel or the compression.

Some experimental treatment modalities for intractable facial pain include direct electrical stimulation of the contralateral motor cortex by epidural electrodes.^10,11

Sphenopalatine Neuralgia

Sluder first described this neuralgia in 1905 and observed that some patients recovering from inflammation of ethmoid and sphenoid sinuses were left with residual neuralgic pain. He attributed it to the spread of inflammation to the spheno-palatine ganglion and described a syndrome that included neuralgic, motor, sensory and gustatory symptoms. Sluder named it a “lower-half headache.”¹²

The sphenopalatine ganglion is a small traingular structure situated between the sphenoid and maxillary bones, behind the middle turbinate of the nase, 1-9 mm from the lateral nasal wall but separated from the nasal cavity by mucus membrane. It is the relay station through which many nerves pass and therefore problems with this region will cause dysfunction of nerves passing through it. The nerves passing through this ganglion include the maxillary nerve (sensory supply to nose, palate, tonsils and gums), greater petrosal and deep petrosal nerves (taste sensation, lacrimation and salivation) and medial pterygoid nerve which innervates the muscles of the soft palate. Irritation of the ganglion may therefore cause problems in the sensory, motor and autonomic functioning of the nose, mouth, and throat.

Etiology

This neuralgia can be idiopathic or secondary to irritation of the sphenopalatine ganglion due to infection of the sphenoid or posterior ethmoid sinuses, intranasal deformities, or scarring from previous sinus surgery. Some correctable intranasal deformity is often found with this neuralgia and therefore a thorough examination of the nasal and paranasal sinuses using imaging is essential.

Signs and Symptoms

Unilateral burning or aching pain initially starts at the base of nose, and then involves the cheek, eye, teeth, frontotemporal and mastoid region. Bilateral pain can occur on rare occasions. A metallic taste before or during attack and decreased taste sensation have been reported. Parasympathetic hyperfunctioning during an attack of pain include lacrimation, conjunctival injection, nasal obstruction, rhiniorrhoea and serous nasal discharge.

On neurological exam, there may be either loss of sensation or hyperesthesia of soft palate, pharynx, tonsils or nose. Sometimes elevation of the palatine arch on affected side and deviation of the uvula to the non-affected side can be seen.

Diagnosis

Diagnosis can be confirmed if symptoms are relieved by a sphenopalatine block, which can be achieved either by intranasal application of 5% cocaine solution, or a selective injection of 1% lidocaine through the greater palatine foramen. CT Scan or MRI of the paranasal sinuses to rule out underlying secondary pathology should be done.

Differential Diagnosis

Cluster Headaches can have a very similar presentation to this neuralgia. However the characterisitic periodicity and predominant severe stabbing eye pain is lacking in sphenopalatine neuralgia.

Treatment

Treatment of the underlying etiology is the first and foremost therapy for these patients. Infection of paranasal sinuses is usually treated with antibiotics or irrigation and drainage. Correction of anatomical defects, if any, should be done.

Destruction of the ganglion by surgical ganglionectomy¹³ or irradiation of the ganglion though the lateral wall of the nasal cavity by contact helium-neon laser has been described. Destruction can also be achieved by injection of 0.5 ml of 5% Phenol in 95% alcohol into the pterygopalatine fossa, if symptoms persist. Iontophoresis of the ganglion, which is a form of electro osmosis that introduces an electrical current into the tissue, is also a mode of therapy.

Combined Hyperactive Dysfunction Syndrome

Multiple cranial neuralgias involving the 5th, 7th, and 9th cranial nerves can occur together in the same patient. Thus a patient may present with trigeminal neuralgia (irritation of 5th cranial nerve), hemifacial spasm (irritation of 7th cranial nerve), and glossopharyngeal neuralgia at the same time. This condition is described as combined hyperactive dysfunction syndrome.¹⁴ This syndrome is most often secondary to irritation of the nerve roots due to compression by blood vessels which are usually situated too close to these nerve roots. Surgical treatment with separation of the artery from the nerve called microvascular decompression is the treatment of choice.

Conclusion

When patients present with persistent burning or lancinating paroxysmal pain in the facial region and no clear etiology, one should consider neuropathic pain in the diagnosis. There are many modalities of therapy currently available for such patients. Early recognition and treatment will also avoid the long-term psychological and physiological consequences of chronic pain. All neuropathic pain patients should be screened for presence of anxiety or depression commonly seen in such patients. It is important to treat these common comorbidities for successful management of the neuropathic pain. n

Last updated on: January 5, 2012

Numb Nose Symptoms, Causes & Common Questions

Multiple sclerosis (ms)

Multiple sclerosis, or MS, is a disease of the central nervous system. The body’s immune system attacks nerve fibers and their myelin covering. This causes irreversible scarring called “sclerosis,” which interferes with the transmission of signals between the brain and the body.

The cause is unknown. It may be connected to a genetic predisposition. The disease usually appears between ages 20 to 50 and is far more common in women than in men. Other risk factors include family history; viral infections such as Epstein-Barr; having other autoimmune diseases; and smoking.

Symptoms include numbness or weakness in arms, legs, or body; partial or total loss of vision in one or both eyes; tingling or shock-like sensation, especially in the neck; tremor; and loss of coordination.

Diagnosis is made through patient history, neurological examination, blood tests, MRI, and sometimes a spinal tap.

There is no cure for MS, but treatment with corticosteroids and plasma exchange (plasmapheresis) can slow the course of the disease and manage symptoms for better quality of life.

Rarity: Rare

Top Symptoms: severe fatigue, constipation, numbness, decreased sex drive, signs of optic neuritis

Urgency: Primary care doctor

Mild frostbite of the nose

Frostbite is tissue damage caused by exposure to the cold (at or below 32F or 0C). It is most commonly found in people doing leisurely activities like camping, hunting, or snow sports. It is also more likely in those who are intoxicated or have a mental disorder.

Rarity: Rare

Top Symptoms: nose pain, swollen nose, nose redness, numb nose, nose coldness

Symptoms that always occur with mild frostbite of the nose: nose coldness

Urgency: Hospital emergency room

Frostnip of the nose

Frostnip is damage of the outermost layers of the skin caused by exposure to the cold (at or below 32F or 0C). It is most commonly found in people doing leisurely activities like camping, hunting, or snow sports.

Rarity: Rare

Top Symptoms: nose pain, nose redness, numb nose, nose coldness, turning blue or purple from coldness

Symptoms that always occur with frostnip of the nose: nose coldness

Urgency: In-person visit

Hypoparathyroidism

Hypoparathyroidism is a condition in the parathyroid glands do not produce enough parathyroid hormone. This leads to low levels of calcium in the blood, which can cause both short-term and long-term symptoms. Causes of hypoparathyroidism include surgery or radiation to the neck, aut..

Diabetic neuropathy

Diabetic neuropathy is nerve damage caused by longstanding or poorly controlled diabetes mellitus (DM). Other risk factors for developing diabetic neuropathy include obesity, smoking, cardiovascular disease, and abnormal lipid levels.

Diabetic neuropathy can present as a number ..

Chronic idiopathic peripheral neuropathy

Peripheral neuropathy refers to the feeling of numbness, tingling, and pins-and-needles sensation in the feet. Idiopathic means the cause is not known, and chronic means the condition is ongoing without getting better or worse.

The condition is most often found in people over age 60. Idiopathic neuropathy has no known cause.

Symptoms include uncomfortable numbness and tingling in the feet; difficulty standing or walking due to pain and lack of normal sensitivity; and weakness and cramping in the muscles of the feet and ankles.

Peripheral neuropathy can greatly interfere with quality of life, so a medical provider should be seen in order to treat the symptoms and reduce the discomfort.

Diagnosis is made through physical examination; blood tests to rule out other conditions; and neurologic and muscle studies such as electromyography.

Treatment involves over-the-counter pain relievers; prescription pain relievers to manage more severe pain; physical therapy and safety measures to compensate for loss of sensation in the feet; and therapeutic footwear to help with balance and walking.

Rarity: Rare

Top Symptoms: distal numbness, muscle aches, joint stiffness, numbness on both sides of body, loss of muscle mass

Urgency: Primary care doctor

Low calcium level

Hypocalcemia is a condition where there is not enough calcium in the blood. Calcium is a mineral contained in the blood, which helps the heart and other muscles function properly, and is needed to maintain strong teeth and bones.

Rarity: Rare

Top Symptoms: fatigue, shortness of breath, irritability, general numbness, tingling foot

Urgency: Primary care doctor

Facial Pain, Trigeminal Neuralgia | Cincinnati, OH Mayfield Brain & Spine

Overview

Trigeminal neuralgia is extreme pain and muscle spasms in the face. Attacks of intense, electric shock-like facial pain can occur without warning or be triggered by touching specific areas of the face. Although the exact cause of trigeminal neuralgia is not fully understood, a blood vessel is often found compressing the nerve. Medication, injections, surgery, and radiation may be used to treat the pain. Each treatment offers benefits, but each has limitations. You and your doctor should determine which treatment is best for you.

What is trigeminal neuralgia?

Neuralgia is severe pain caused by injury or damage to a nerve. The trigeminal nerve is the fifth (V) cranial nerve, which arises from the brainstem inside the skull. It divides into three branches and then exits the skull to supply feeling and movement to the face (Fig. 1):

Ophthalmic division (V1) provides sensation to the forehead and eye.
Maxillary division (V2) provides sensation to the cheek, upper lip, and roof of the mouth.
Mandibular division (V3) provides sensation to the jaw and lower lip; it also provides movement of the muscles involved in biting, chewing, and swallowing.

Figure 1. The trigeminal nerve supplies feeling and movement to the face. It has three divisions that branch from the trigeminal ganglion: ophthalmic division (V1) provides sensation to the forehead and eye, maxillary division (V2) provides sensation to the cheek, and mandibular division (V3) provides sensation to the jaw.

When the trigeminal nerve becomes irritated, an attack of intense pain results. Also called tic douloureux because of the uncontrollable facial twitching caused by the pain, trigeminal neuralgia is serious because it interferes with many aspects of a person’s life. Typical trigeminal neuralgia involves brief instances of intense pain, like an electrical shock in one side of the face. This pain comes in repeated waves that last an hour or more. The patient may initially experience short, mild attacks, with periods of remission. But trigeminal neuralgia can progress, causing longer, frequent attacks of searing pain.

What are the symptoms?

Patients describe an attack as a “pins and needles” sensation that turns into a burning or jabbing pain, or as an electrical shock that may last a few seconds or minutes. Everyday activities can trigger an episode. Some patients are sensitive in certain areas of the face, called trigger zones, which when touched cause an attack (Fig. 2). These zones are usually near the nose, lips, eyes, ear, or inside the mouth. Therefore, some patients avoid talking, eating, kissing, or drinking. Other activities, such as shaving or brushing teeth, can also trigger pain.

Figure 2. Facial areas of trigger zones. Trigger points (circles) have the greatest sensitivity.

The pain of typical trigeminal neuralgia usually has the following features:

Affects one side of the face
Can last several days or weeks, followed by a remission for months or years
Frequency of painful attacks increases over time and may become disabling

A less common form of the disorder, called atypical trigeminal neuralgia, causes a less intense, constant, dull burning or aching pain. This pain sometimes occurs with occasional electric shock-like stabs that may last a day or more. Atypical facial pain is more difficult to treat.

What are the causes?

Many believe that the protective sheath of the trigeminal nerve deteriorates, sending abnormal messages along the nerve. Like static in a telephone line, these abnormalities disrupt the normal signal of the nerve and cause pain. Several factors can cause the deterioration of this protective sheath: aging, multiple sclerosis, and tumors; but most doctors agree that it is most often caused by an abnormal vein or artery that compresses the nerve.

Some types of facial pain can result from an infected tooth, sinus infections, shingles or postherpetic neuralgia, or previous nerve injury.

Who is affected?

Trigeminal neuralgia affects 5 in every 100,000 people and occurs slightly more in women than men. Patients are usually middle age and older. Some people with multiple sclerosis also develop trigeminal neuralgia.

How is a diagnosis made?

When a person first experiences facial pain, a primary care doctor or dentist is often consulted. If the pain requires further evaluation, a consultation with a neurologist or a neurosurgeon may be recommended. The doctor examines and touches areas of your face to determine exactly where the pain is occurring and which branches of the trigeminal nerve may be affected.

The underlying causes of trigeminal neuralgia are rarely serious. However, the possibility of a tumor or multiple sclerosis must be ruled out. Therefore, a magnetic resonance imaging (MRI) scan is usually performed. An MRI scan can detect any blood vessels compressing the nerve (Fig. 3). The diagnosis of trigeminal neuralgia is made after carefully assessing the patient’s symptoms.

Figure 3. MRI can detect blood vessels (arrow) that may be compressing the trigeminal nerve.

What treatments are available?

A variety of treatments are available, including medication, surgery, needle procedures, and radiation. First line treatment is medication. When medications fail to control pain or cause intolerable side effects, a neurosurgeon may be consulted to discuss other procedures.

Medication
Over-the-counter drugs such as aspirin and ibuprofen are not effective against trigeminal neuralgia. Anticonvulsants and muscle relaxants are prescribed to block the pain signals from the nerve. These medications are the initial treatment for trigeminal neuralgia and are used as long as the pain is controlled and the side effects do not interfere with a patient’s activities. About 80% of patients experience at least short-term pain relief with medications. For effective pain control, medications must be taken on a regular schedule to maintain a constant level in the blood.

Anticonvulsants, such as carbamazepine (Tegretol), oxcarbazepine (Trileptal), gabapentin (Neurontin), phenytoin (Dilantin), lamotrigine (Lamictal), and pregabalin (Lyrica) are used to control trigeminal neuralgia pain. If the medication begins to lose effectiveness, the doctor may increase the dose or switch to a different drug. Side effects may include drowsiness, unsteadiness, nausea, skin rash, and blood disorders. Therefore, patients are monitored routinely and undergo blood tests to ensure that the drug levels remain safe and that blood disorders do not develop. Multiple drug therapy may be necessary to control pain (e.g., Tegretol combined with Neurontin).
Muscle relaxants, such as baclofen (Lioresal), are sometimes effective in treating trigeminal neuralgia. Side effects may include confusion, nausea, and drowsiness.

Surgery
The goal of surgery is to stop the blood vessel from compressing the trigeminal nerve, or to cut the nerve to keep it from sending pain signals to the brain. Surgical procedures are performed under general anesthesia, involve opening a hole in the skull (called a craniotomy), and require a 1 to 2 day hospital stay.

Microvascular decompression (MVD) is a surgery to gently reroute the blood vessel from compressing the trigeminal nerve by padding the vessel with a sponge. A 1-inch opening is made in the skull behind the ear, called a craniotomy. This opening exposes the trigeminal nerve at its connection with the brainstem. A blood vessel is often found compressing the nerve. After the nerve is freed from compression, it is protected with a small Teflon sponge (Fig. 4). The sponge remains in the brain permanently.
MVD provides immediate pain relief in 95% of patients [1]. About 20% of patients have pain recurrence within 10 years. The major benefit of MVD is that it causes little or no facial numbness. The major disadvantages are the risks of anesthesia and of undergoing an operation near the brain.

Figure 4. During MVD, a sponge is inserted between the trigeminal nerve and the blood vessel to relieve the compression that causes the painful neuralgia attacks.

Sensory rhizotomy is the irreversible cutting of the trigeminal nerve root at its connection to the brainstem. A small opening is made in the back of the skull. A stimulation probe is used to identify the motor root of the nerve. The motor root, which controls the chewing muscles, must be preserved. The sensory root fibers, which transmit the pain signals to the brain, are severed (Fig. 5). Cutting the nerve causes permanent facial numbness and should only be considered for recurrent pain that has not responded to other treatments.

Figure 5. During sensory rhizotomy, the sensory root fibers are cut, but the motor root is preserved.

Peripheral neurectomy is a type of surgery that can be performed to the nerve branches by exposing them on the face through a small skin incision. Cutting the supraorbital nerve (branch of V1 division) may be appropriate if pain is isolated to the area above the forehead. Cutting the infraorbital nerve (branch of V2 division) may be performed if pain is limited to the area below the eye along the upper cheekbone. Cutting the nerve causes complete facial numbness in the region the nerve supplies.

Radiosurgery
Radiosurgery is a noninvasive outpatient procedure that uses highly focused radiation beams to destroy some of the trigeminal nerve root fibers that produce pain. The two main technologies are the Leksell Gamma Knife and linear accelerator systems such as the BrainLab Novalis. A stereotactic head frame or facemask is attached to the patient’s head to precisely localize the nerve on an MRI scan and to hold the head perfectly still during treatment. Highly focused beams of radiation are delivered to the trigeminal nerve root (Fig. 6). In the weeks after treatment, a lesion (injury) develops where the radiation occurred.

Pain relief may not occur immediately but rather gradually over time. As a result, patients continue to take pain medication for a period of time. The success of radiosurgery becomes clear when pain medication is reduced or eliminated. After 4 weeks, about 50% of patients will experience pain relief without medication or with reduced medication. After 8 weeks, 75% will have pain relief without medication or with reduced medication [3]. Complications include facial numbness and dry eye. In about 30% of patients, pain recurs 3 to 5 years after treatment [4]. Repeat radiosurgery can be effective; however, the risk of facial numbness is increased.

Figure 6. During radiosurgery, the patient’s head is immobilized and beams of radiation are focused on the trigeminal nerve (top). The MRI (bottom) shows a red circle radiation dose delivered to the cisternal segment of the trigeminal nerve to damage the nerve fibers.

Outpatient needle procedures
Needle procedures are minimally invasive techniques for reaching the trigeminal nerve through the face without a skin incision or skull opening. They are performed with a hollow needle inserted through the skin (percutaneous) of the cheek into the trigeminal nerve at the base of the skull (Fig. 7). The goal of rhizotomy or injection procedures is to damage an area of the trigeminal nerve to keep it from sending pain signals to the brain. Damaging the nerve causes mild to major facial numbness in that area. A degree of facial numbness is an expected outcome of the procedure and is necessary to achieve long-term pain relief. These outpatient procedures are typically performed under local anesthesia and light sedation. Patients usually go home the same day.

Figure 7. For needle procedures, a hollow cannula is inserted near the corner of the mouth. It is passed through the cheek and into a hole in the skull to reach the trigeminal ganglion. Through the cannula an electrode, liquid glycerol, or balloons are passed.

Radiofrequency rhizotomy, also called Percutaneous Stereotactic Radiofrequency Rhizotomy (PSR), uses a heating current to selectively destroy some of the trigeminal nerve fibers that produce pain. While asleep, a hollow needle and electrode are inserted through the cheek and into the nerve. The patient is awakened and a low current is passed through the electrode to stimulate the nerve. Based on your feedback, the surgeon positions the electrode so that tingling occurs where your painful attacks are located. Once the pain-causing area is located, the patient is put back to sleep and a heating current is passed through the electrode to damage only that portion of the nerve (Fig. 8A).
PSR provides immediate pain relief for 98% of patients [1]. About 20% of patients experience pain recurrence within 15 years. Medication, repeat PSR, or another surgical procedure can be considered. Complications may include double vision, jaw weakness, loss of corneal reflex, dysesthesia (troublesome numbness) and very rarely anesthesia dolorosa. Partial facial numbness in the area where the pain existed is expected. Other complications, such as blurred vision or chewing problems, are usually temporary.
Glycerol injection is similar to PSR in that a hollow needle is passed through the cheek to the nerve. The needle is positioned in the trigeminal cistern (a fluid-filled area in the ganglion) (Fig. 8B). Glycerol is injected into the cistern to damage some of the trigeminal nerve fibers that produce pain. Because the location of the glycerol cannot be controlled precisely, the results are somewhat unpredictable.
Glycerol injection provides immediate pain relief in 70% of patients [2]. About 50% of patients experience pain recurrence within 3 to 4 years. As with PSR, partial facial numbness is expected and complications are similar.
Balloon compression is similar to PSR in that a hollow needle is passed through the cheek to the nerve. However, it is performed under general anesthesia. The surgeon places a balloon in the trigeminal nerve through a catheter. The balloon is inflated where fibers produce pain (Fig. 8C). The balloon compresses the nerve, injuring the pain-causing fibers. After several minutes the balloon and catheter are removed.
Balloon compression provides immediate pain relief for 80% of patients [2]. About 20% of patients experience pain recurrence within 3 years. Complications may include minor numbness, chewing problems, or double vision.

Figure 8. A. In radiofrequency rhizotomy, a heating current selectively destroys nerve fibers in V1, V2, or V3. B. In glycerol injection, alcohol (green) damages nerve fibers in the cistern; it is not selective to a specific division of the nerve. C. In balloon compression, inflation compresses the nerve fibers; it may be selective.

Clinical trials

Clinical trials are research studies in which new treatments—drugs, diagnostics, procedures, and other therapies—are tested in people to see if they are safe and effective. Research is always being conducted to improve the standard of medical care. Information about current clinical trials, including eligibility, protocol, and locations, are found on the Web. Studies can be sponsored by the National Institutes of Health (see clinicaltrials.gov) as well as private industry and pharmaceutical companies (see www.centerwatch.com).

Recovery

No one procedure is best for everyone and each procedure varies in its effectiveness versus side effects. Microvascular decompression (MVD) and radiofrequency rhizotomy (PSR) have comparable rates of long-term pain relief that are highest among the available options. In a study of approximately 100 patients or more published in the past 10 years, the rates of pain relief were 77% in 7 years for MVD and 75% in 6 years for PSR rhizotomy. Of patients treated with radiosurgery, an appropriate treatment for those who cannot undergo MVD or who wish to avoid the facial numbness associated with PSR, 60% have pain relief for 5 years.

Trigeminal neuralgia can recur in divisions of the nerve previously free of pain. This can occur following all treatments and may represent progression of the underlying disorder rather than recurrence.

Sources & links

If you have more questions, contact Mayfield Brain & Spine at 800-325-7787 or 513-221-1100.

Support
Support groups provide an opportunity for patients and their families to share experiences, receive support, and learn about advances in treatments, pain control, and medications. Please contact the TNA Facial Pain Association at 800-923-3608.

Sources

Taha JM, Tew JM Jr: Comparison of surgical treatments for trigeminal neuralgia: Reevaluation of radiofrequency rhizotomy. Neurosurgery 38:865-871, 1996
Tew JM: Therapeutic Decisions in Facial Pain. Clinical Neurosurgery 46:410-431, 2000
Tuleasca, C., Resseguier, N., Donnet, A., Roussel, P., & Gaudart, J. Patterns of pain-free response in 497 cases of classic trigeminal neuralgia treated with Gamma Knife surgery and followed up for at least 1 year. Journal of Neurosurgery, 117 Suppl, 181–188, 2012
Gronseth G, et al.: Practice Parameter: The diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review). Neurology 71:1183-90, 2008

Links
TNA Facial Pain Association, www.fpa-support.org
American Pain Society, www.ampainsoc.org
Trigeminal Neuralgia Diagnostic Questionnaire

Glossary

anesthesia dolorosa: constant pain felt in an area of total numbness; similar to phantom limb pain.

anticonvulsant: a drug that stops or prevents convulsions or seizures.

dysesthesia: a numbness, crawling, or unpleasant sensation that a person considers disturbing.

glycerol: an oily fluid that can be injected into a nerve to destroy its pain-producing portion.

multiple sclerosis: a chronic degenerative disease of the central nervous system in which the myelin (sheath) surrounding the nerves is destroyed.

neuralgia: nerve pain.

neurectomy: cutting of a nerve to relieve pain.

percutaneous: through the skin.

postherpetic neuralgia: chronic pain that persists after shingles rash and blisters have healed.

radiofrequency: radiant energy of a certain frequency.

neurectomy: cutting of a nerve for the relief of pain.

rhizotomy: interruption or destruction of a group of nerve fibers by chemical or radiowaves.

percutaneous: by way of the skin (e.g, injection).

shingles (herpes zoster): a viral infection that causes a painful skin rash and blisters along the course of a nerve; a reactivation of chickenpox.

tic douloureux: French for trigeminal neuralgia.

updated > 7.2018
reviewed by > Steven Bailey, MD and Ronald Warnick, MD, Mayfield Clinic, Cincinnati, Ohio

Mayfield Certified Health Info materials are written and developed by the Mayfield Clinic. We comply with the HONcode standard for trustworthy health information. This information is not intended to replace the medical advice of your health care provider.

5 Signs of a Pinched Nerve

Your nerves’ job is to transmit signals from one point to another in your body. “Anything that blocks that signal from occurring will result in some manifestation of symptoms,” Dr. Danan says. A pins-and-needles feeling usually means that a sensory nerve is being compressed, he says.

2. You have numbness or decreased sensation in one area of your body.

This has a lot to do with pressure causing poor blood flow to the nerve, Dr. Shamie says, offering the example of “being unable to feel your arm in the morning when you wake up because you were lying on it.” Pressure can cause issues with the nerves’ ability to fire, he says. As a result, your hand or arm might feel numb until you relieve the pressure that’s blocking the blood flow.

3. It feels like your hand or foot falls asleep a lot.

If you notice that this tends to happen when you sit on your leg or rest your arm a certain way, then it goes away when you move, it’s highly likely that you’re just compressing the nerve temporarily with your position, Dr. Danan says. But if it happens seemingly out of nowhere and you’re not sure why, it’s important to check in with a doctor to see what might be causing the compression.

4. You have a sharp, aching, or burning pain, and it might radiate outward.

This can happen because something near the nerve is inflamed and compressing it, or the nerve itself is inflamed, Dr. Shamie says. “It’s your body’s way of alerting you that something is going on.”

For the record, you’ll probably have pain that’s not in the area where the nerve is being compressed, Dr. Danan says. Instead you’ll feel it where the nerve ends, like in the lower part of your leg or your hand. Sciatica, which is zapping pain that shoots down the sciatic nerve that begins in your lower back and goes into one or both legs, is a common pinched nerve issue, Neel Anand, M.D., professor of orthopaedic surgery and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles, tells SELF. “It can seemingly come out of nowhere, leaving you stunned,” he says.

5. You have muscle weakness in one area of your body.

Remember when we talked about the different types of nerves in your body? Muscle weakness is usually a sign that one of your motor nerves, the ones that carry messages from your brain to your muscles, is pinched, Dr. Danan says. This is generally a signal that the muscle that’s connected with the nerve isn’t being told to operate the way it should.

Many of these symptoms could also signal other medical conditions, including a stroke, heart attack, multiple sclerosis, and seizures. Unless these symptoms strike in a way that makes sense—like when you’ve kept your leg curled up under you for way too long—and go away when you change whatever is putting pressure on the nerve, you should see a doctor for evaluation. This is especially true if these symptoms come along with anything like coordination issues, trouble breathing, or other signs that this may be more than a pinched nerve.

You can reduce the risk of getting a pinched nerve.

As we’ve mentioned, certain risk factors increase your chances of dealing with a pinched nerve (like diabetes and pregnancy). The good news is that you can do a few things to mitigate risk. For instance, you might try to maintain a good posture when you’re sitting down for long periods. As comfortable as it is to cross your legs or lean on your side, this can put undue stress on your body, the Mayo Clinic explains. If you spend hours sitting for work, make a point of getting up and moving around, the University of Rochester Medical Center suggests.

90,000 How does trigeminal neuralgia manifest itself, is it possible to get rid of this disease on your own?

Any pain that occurs in our body impedes rest, interferes with work and rest. Pain in the head area caused by trigeminal neuralgia is especially difficult. And although most often it occurs in the form of seizures, the very possibility of its appearance keeps a person in constant tension.

Most often, neuralgia is limited to pain along one of the three branches of the nerve.Each of these branches is responsible for its own part of the face: the orbital nerve – for the forehead, the back of the nose; maxillary – for the cheeks, nose, temporal region; mandibular – for the lower jaw and temporal region, respectively.

Since the trigeminal nerve is mainly sensitive, that is, it transmits data from external stimuli to the brain, its damage leads to pain syndrome. Before an attack, its precursors usually appear – itching in a certain part of the face, “creeping creeps”, and other sensory disturbances.Then the attack itself begins. It can be a growing burning pain lasting up to several days, or short-term (from several seconds to 2-3 minutes) severe shooting pains. Usually the pain is localized in one half of the face and is limited to the area where the nerve is located. Moreover, it can be so strong that it completely unsettles a person.

Talking, chewing, taking hot, cold or spicy food can provoke an attack. Colds, sinusitis, runny nose, herpetic lesions also lead to more frequent paroxysms of pain.During an attack, patients often resort to proven measures – some forcefully press on the painful area or rub it, others freeze in a peculiar position (for example, with an open mouth or closed eyes).

This pathology is most common in people in adulthood, more often in women. The disease lasts for a long time, periodic exacerbations alternate with the so-called light intervals. The etiology of the disease is not fully understood. It is believed that the nerve can be compressed by pathologically altered vessels, less often by a tumor.In some cases, the onset of pain may be related to a previous injury.

Treatment with conventional pain medications is ineffective and, if taken uncontrolled, can lead to serious complications. Patients with a similar pathology should consult a neurologist. Therapy is based on the use of anticonvulsants, which usually give long-term remission. They are prescribed under the strict supervision of a doctor. However, sometimes this method does not lead to positive results, and then you have to resort to surgical treatment.

Prevention of relapse of the disease is based on the observance of the regime of work and rest, full and balanced nutrition, reduction of stress loads. Patients should be wary of hypothermia, drafts. You need to be serious about colds, any manifestations of herpes infection. And be sure to visit your dentist regularly. Self-medication for this pathology is completely inappropriate, especially since potent drugs are used in the treatment, which, as already noted, must be taken under the supervision of a physician.

Yuri Kuzmenkov, doctor of the Republican Scientific and Practical Center “Cardiology”

The doctor’s sphere of interests is therapy, cardiology, endocrinology.
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Trigeminal neuralgia: symptoms and treatment

Trigeminal neuralgia is very noticeable: pain can last for a long time, be paroxysmal, excruciating .The earlier you start therapy in our clinic, the more chances for success. Neurological doctors diagnose the disease using the most modern equipment and prescribe you an individual complex therapy. By contacting our professionals, you will receive highly qualified assistance and minimize health risks.

About the disease

Our two trigeminal nerves determine the sensitivity of the face. One nerve runs to the left, the other to the right. Each has three branches.

With neuralgia of the right or left nerve, bouts of shooting intense pain begin in the locations of the nerve branches .Pain does not allow you to live an active life: for example, there are difficulties with eating, observing a hygienic regime. You can get sick at any age. More often women are ill.

The disease can occur on its own or be a complication of another disease.

Causes of occurrence

Abnormal location of the cerebral vessels, which provokes compression of the nerve in the zone of its exit from the cranial cavity;
Vascular aneurysm;
Chronic infectious diseases of the facial area (including dental caries) sinusitis;
Hypothermia of the face;
Brain tumor.

Signs of the disease that you cannot fail to notice

Most often, pain occurs in the jaw area or one half of the face. It may seem to you that if the pain occurs for the first time, that the cause of it lies in the teeth, since the pain begins, as a rule, in the upper or lower jaw.

Pain is constant, sometimes intensifying, paroxysmal, instantaneous, pulsating. Doctors classify pain as atypical and typical.

Typical is characterized by periods of exacerbation and regular abatement for a short time.Some people rarely experience pain, for example, once a day, while others flare up every hour. The pain seems to shock, reaches a peak in 20 seconds, lasts for a while, then gradually subsides.
Atypical pain covers part of the face, lasts without subsiding. Such neuralgia is very difficult to treat.

Most often, exacerbations occur in spring and autumn.

Diagnosis of trigeminal neuralgia

Diagnosis begins with finding out the cause of the pain, firstly, ENT organs are examined, and a dental examination is carried out.

As a rule, the diagnosis is not difficult. The clinic will also conduct a neurological examination, in doubtful cases, they will resort to additional research. These are:

general blood and urine tests;
Panoramic X-ray of the oral cavity;
magnetic resonance imaging;
X-ray of the paranasal sinuses;
electromyography and electroneurography.

Treatment in our clinic

Our doctors will start with medication.Surgical will be used in special cases. If you suffer from this disease, the specialists of the clinic guarantee a significant increase in the interval of remission: this means that you can live without pain for a long time.

The clinic’s specialists will prescribe you antihistamines, anticonvulsants, antispasmodics, vasodilators. Drug treatment is aimed at eliminating pain, preventing recurrent attacks. Physiotherapeutic methods also help relieve pain: ionogalvanization with novocaine, phonophoresis with hydrocortisone, electrophoresis, percutaneous electrical stimulation, diadynamic therapy, laser infrared therapy.

Vitamin therapy is also very important, especially B vitamins are shown: in the acute period of the disease they are often administered in the form of injections together with ascorbic acid.

If conservative therapy is powerless, surgical intervention is necessary.

Modern operations are performed using non-invasive methods and involve the correction of areas of arteries that compress your nerve. The so-called Cyberknife completely eliminates pain syndrome. When using this system, the required dose of radiation is delivered to the pathways of the nerve with absolute precision.Experts guarantee the high efficiency of this technique.

Prevention: what you can do to avoid getting sick

To avoid trigeminal neuralgia, we advise you to start treating inflammation of the paranasal sinuses on time, do not overcool, monitor the condition of your teeth, the entire dentoalveolar system, avoid injuries, infections, vitamin deficiencies.

It is necessary to remember about the inadmissibility of self-diagnosis and treatment. Traditional medicine relieves pain syndrome only for a short time.To maximize the success of the treatment, the diagnosis and the choice of the therapy regimen should be left to the experienced neurologist of our clinic.

Trigeminal neuralgia

TRIPLE NERVE NEURALGY

Trigeminal neuralgia (trigeminal neuralgia) is a chronic disease that affects the trigeminal nerve, with paroxysmal pain in the branches of the trigeminal nerve.

There are a lot of reasons due to which neuralgia develops, including compression by the vessels of the nerve in the cranial cavity (neurovascular conflict). Trigeminal neuralgia can appear due to hypothermia, infectious diseases of a chronic nature – caries, sinusitis, also with a tumor in the brain and other diseases.

Features of the trigeminal nerve

The trigeminal nerve is a mixed nerve and has motor and sensory nuclei in the brain stem.This is the fifth pair of 12 cranial nerves. The trigeminal nerve has three branches:

1. The first branch – innervates the skin of the forehead and the anterior third of the scalp, or rather the eyelid, the inner corner of the eye and the back of the nose, the eyeball, the nasal mucosa, meninges.

2. The second branch is responsible for the innervation of the lower eyelid, the outer corner of the eye, part of the skin on the lateral surface of the face, the upper part of the cheek, upper jaw, upper lip, mucous membranes of the upper jaw, teeth, maxillary cavity.

3. The third branch is mixed. Sensory fibers innervate the lower lip, the lower part of the cheek, the chin, the posterior part of the lateral and surface of the face, the lower jaw, its gums and lower teeth, the mucous membranes of the cheeks, the tongue. Motor fibers innervate the chewing muscles.

With the defeat of one branch of the trigeminal nerve, there is a disturbance of sensitivity in the zone of its autonomous innervation. When the Gasser node from the root of the trigeminal nerve is involved in the process, the loss of sensitivity occurs in the autonomy of all three branches.

Due to the presence of sympathetic fibers in the trigeminal nerve system, sweating disorders, vasomotor phenomena and trophic disorders are possible, which are especially dangerous in the cornea of the eye.

Symptoms of trigeminal neuralgia

This disease is typical for older people and occurs more often in women after 40 years. In this case, a strong, shooting pain appears, which is one-sided, very rarely on both sides of the face.The attack lasts from 3-4 to 15-20 seconds, in severe cases up to 2 minutes. During the day, up to 30-40 painful paroxysms are possible. Over time, the localization of pain is unchanged, if it is characteristic of one side, then it is there.

The pain is usually “trigger”, that is, when the zones are irritated (touch, cough, talking, chewing), an attack of pain occurs. The pain in trigeminal neuralgia is never nighttime.

Pain can be spontaneous and occur due to something.Also, neuralgia pain is divided into typical and atypical. Typical pain is characterized by periods of fading, and the pain can be shooting. Atypical pain is constant, it can cover a large area of the face, while it does not stop. Such neuralgia is very difficult to treat.

Neuralgia refers to a cyclical disease when exacerbation alternates with subsiding.

Treatment of trigeminal neuralgia

In trigeminal neuralgia, it is very important to reduce pain.The main drug that is used is carbamazepine, the dosage is chosen by the doctor. After 3 days, pain relief can be noticed, but the drug lasts no more than 4 hours.

The therapy lasts until the patient gets better, maybe up to six months. Currently, the drug of choice is the drug “lyrica”, the appointment and dosage with the treatment regimen is prescribed by a neurologist.

With physiotherapy treatments, pain can be relieved, but not cured

The methods of destruction of the branches of the nerve are in the past.

Neurovascular conflicts are eliminated by surgical treatment, but at the same time it is necessary to clearly prove during the examination, its presence, otherwise there will be no result from the treatment

An effective and safe method of trigeminal neuralgia is radiosurgery using the Gamma Knife technique, which is currently the “gold standard in the treatment” of trigeminal pain.

Gamma Knife is the treatment of choice in the treatment of trigeminal neuralgia. The indication for the “Gamma Knife” treatment is the desire of the patient with a pharmacoresistant course of trigeminal neuralgia.

The only drawback in radiosurgical treatment is the duration of the onset of the treatment effect, which sometimes can take from 4 to 6 months from the moment of the performed radiosurgery

Fig. 1 Target of radiosurgical treatment – the root of the trigeminal nerve at the entry into the brainstem

90,000 Symptoms, treatment of neuralgia at the Elena Malysheva clinic in Izhevsk

Neuralgia is a disease provoked by damage to peripheral nerves, which leads to their inflammation.The result is a pain syndrome that runs along the nerve fibers and is localized in the innervation zone. The pathological condition can manifest itself at any age. In case of untimely access to a doctor, it progresses.

The Department of Neurology of the Elena Malysheva Clinic provides diagnostics and treatment of neuralgia of various etiologies. Reception is conducted by certified specialists who have a comprehensive approach to providing assistance to each patient, choosing methods of medical intervention, taking into account the individual characteristics of the organism and the causes of the disease.Remember that a timely visit to a neurologist will reduce the risk of unwanted consequences, shorten the time of treatment and rehabilitation.

Causes of the disease

The main cause of neuralgia is inflammation of the peripheral nerves, which appears as a result of:

infectious diseases;
pinched nerve;

90,046 traumatic injuries;

intoxication of the body;

90,046 professional overwork;

severe hypothermia;
benign and malignant tumors;
demyelinating processes;
development of multiple sclerosis;

90,046 complications after surgery and previous diseases;

90,046 stresses;

diseases of the cardiovascular system;
metabolic disorders;
hereditary predisposition.

Symptoms of neuralgia

The main symptom of neuralgia is acute localized pain. It indicates a pathological process. In this case, the symptoms depend on which nerve fiber is injured or inflamed. Accordingly, the following types of neuralgia are distinguished:

Trigeminal nerve. The disease is rapidly progressing, so the pain in the face appears abruptly, paroxysmal. It can last for a few seconds or last for a few minutes. It is often repeated throughout the day.Facial neuralgia is usually located on the right side of the face. In some cases, it can be bilateral. In the later stages, it progresses to the corners of the eyes, the wings of the nose. In this case, pain occurs when brushing teeth, eating, shaving, and applying makeup.
Sciatic nerve. It manifests itself as a burning sensation in the buttocks and lower back, creeping goose bumps syndrome. There are complaints of shooting pains.
Occipital nerve. It is characterized by sudden attacks when exposed to the occipital region, “lumbago” behind the ears or in the back of the neck.It can be localized on one or both sides of the neck and head.
Intercostal. It has a shingles in nature. The painful attack is spontaneous. It is acutely felt during coughing, inhalation, change of body position. The pain lasts up to several days. Often leads to a decrease in the sensitivity of the skin.
Glossopharyngeal nerve. The main symptom is pain at the root of the tongue, accompanied by dry mouth, increased salivation.
Morton’s Syndrome. Occurs when the plantar nerves are affected.The first sign is discomfort in the foot, which turns into bouts of pain. There may be an increased sensitivity of the fingertips. In case of delayed treatment, the disease progresses to inflammation of the sciatic nerve.
Pterygopalatine knot. The manifestation is pain in the upper jaw, which may be accompanied by clattering sounds, redness of the eyes, swelling of the face, and tearing.

Diagnostics

An integral step in the effective treatment of neuralgia is diagnostics, which allows you to accurately diagnose, choose methods of providing assistance to the patient.Diagnostics begins with consultation and examination. Based on the patient’s complaints and the initial examination, the neurologist prescribes general and special tests, such as blood and urine tests, CT, gastroenterology, NMR, EGDS, electro- and echocardiography, X-rays, etc. The types of diagnostics are selected individually, taking into account the specific case.

Additionally, the patient can be referred for consultation and examination to a pulmonologist, cardiologist, gynecologist, therapist, if there are complaints of symptoms similar to a number of other diseases.This allows you to exclude adjacent pathologies.

Treatment of neuralgia

Treatment of neuralgia should be carried out in stages and in a comprehensive manner, which will allow you to choose truly safe and effective methods that will relieve painful sensations and their subsequent relapses. Therefore it is important:

Conduct a conversation with the patient and his initial examination. If contraindications to subsequent treatment are identified, it is necessary to find a way of alternative assistance.
Assign diagnostics.This will allow taking into account the individual characteristics of the organism, the degree of the pathological condition. Additionally, a consultation of related specialists may be prescribed, which will allow for a comprehensive examination and exclude pathologies with similar symptoms.
Determine the methods of treatment, taking into account individual indications. Medical assistance is provided in a comprehensive manner. It is aimed at eliminating symptoms, as well as preventing possible relapses.

Taking into account the symptoms of neuralgia, the doctor prescribes for treatment: drug therapy, physiotherapy, and other types of medical care.

Depending on the type of pathology, the doctor may also prescribe: wearing a corset, a special diet, bed rest, exercise therapy, swimming, other types of procedures and recommendations for lifestyle. In some cases, surgery may be indicated.

Our advantages

Having decided to be treated in the clinic of Elena Malysheva, you can be sure that here:

Affordable prices in Izhevsk. You can get acquainted with the tariffs for different types of services in the price list.In this case, the final cost will be calculated after determining the entire complex of necessary procedures.
Highly qualified specialists. The clinic employs certified doctors with narrow qualifications, which allows you to accurately diagnose based on the manifestations of the disease, prescribe the necessary diagnostics, and offer a treatment program for the identified pathology.
Individual approach to each patient. All procedures are prescribed taking into account the state of the body of patients with illnesses.
Comprehensive solution to the problem. For an accurate diagnosis, a consultation is carried out by several doctors of different specializations.
Advanced treatment methods. Our doctors constantly improve their qualifications, follow the latest in pharmacology and medicine, which makes it possible to choose the most effective method of treatment.
Modern equipment and tools. This helps to provide appropriate assistance, ensuring a comfortable stay in our clinic.
Complete confidentiality. We do not disclose information about our patients. You can contact us with any problem without worrying that information about your disease will become known to your manager, relatives or friends.
Effective and safe treatment. We observe hygiene standards, control the effectiveness of treatment, which is the key to a quick recovery.

Appointment with a neurologist

If you decide to contact Elena Malysheva’s clinic, then you can make an appointment with a neurologist by calling (3412) 52-50-50 or on the clinic’s website.

Damage to the trigeminal nerve – causes, symptoms and treatment – Medcompass

Neuralgia of the trigeminal nerve (according to ICD 10, the defeat of the trigeminal nerve G50.0) is a pathological process that is manifested by very intense pain in the corresponding zone of innervation. It can be one branch of this nerve, or all of its branches.

Taking into account the ongoing pathological changes, it is advisable to distinguish:

Central neuralgia, in which the nucleus of the trigeminal nerve is affected
Peripheral, characterized by damage to the branches of the nerve.

Symptoms of the disease

The main clinical manifestation of trigeminal neuralgia is pain syndrome. It is on the basis of it that you can diagnose neuralgia.

Pain syndrome is characterized by the following manifestations:

The pain is excruciating, forcing the patient to abandon the usual way of life
The pain is different in nature – it can resemble the passage of an electric current, burning, shooting, stabbing, etc.
The area of pain distribution corresponds to the places of innervation of the trigeminal nerve, and also extends to the entire face
The pain is paroxysmal in nature – during the period of an attack, clinical manifestations are most pronounced
Any facial movement causes an increase in pain.

In addition to pain, there may be other manifestations of neuralgia, which include:

Convulsive twitching of the facial muscles or increased tone of facial muscles
Hypersensitivity, even when touched (hyperesthesia)
Feeling of numbness, tingling, creeping, and T.

Causes of the disease

The main causal factors for the development of trigeminal neuralgia are as follows:

Compression (compression) of the nerve by various pathological structures from the outside
Tumor lesions
Inflammatory processes, including the dura mater
Pathological processes in the area of the nose and paranasal sinuses
Traumatic injury to the face
Anomalies of the bite
Increased formation of bone tissue
Aneurysmal vasodilation
Demyelinating diseases of the peripheral nervous system, that is, those accompanied by destruction of the myelin sheath, etc.etc.

In the presence of all of the above causal factors, the presence of predisposing factors is also necessary, which are accompanied by a metabolic disorder in the nervous tissue. The following are predisposing conditions:

Infectious processes
Exposure to toxic substances
Any traumatic injury.

Diagnostics

Diagnosis of trigeminal neuralgia is based on:

Clinical study data
Results of electroneuromyography.

Electroneuromyography is a functional diagnostic method that allows you to assess the condition of a nerve fiber, as well as the conductivity of electrical impulses along it. With the development of inflammatory processes in the nervous tissue, this conductivity is significantly reduced.

Complications

Complications of trigeminal neuralgia usually develop when timely diagnosis and treatment is not carried out. The most common complications are:

Paresis or paralysis of facial muscles on the side of the trigeminal nerve damage
Neuroses against the background of a psychological inferiority complex
Transition of the inflammatory process to the brain tissue and meninges.

Treatment of the disease

Treatment in the presence of trigeminal neuralgia is conservative. Physiotherapeutic procedures, which are prescribed in the stage of unstable remission, have proven themselves very well. They allow you to prevent the progression of the pathological process. The most widely used for neuralgia are:

Ultrasound therapy
Electromagnetic therapy
Electrophoresis with anti-inflammatory drugs.

In the acute stage, the use of the following drugs is shown:

Nonsteroidal anti-inflammatory
Tranquilizers (they slow down the functioning of the nervous system, which provides it with functional rest)
Nootropic (improves the course of metabolic processes in the nervous tissue).

What threatens inflammation of the trigeminal nerve and how to avoid complications | | Infopro54

At the time of the diagnosis and treatment will help to avoid possible complications.

Symptoms

Doctors divide the symptoms of neuralgia into primary and secondary.

The most pronounced signs are classified as primary:

pain;
muscle spasm;
change in skin sensitivity.

The nature of pain in inflammation of the trigeminal nerve is special and is the most striking, pronounced symptom.

Frequent “shooting” attacks.
Localized in one part of the face.
Typical pain occurs during physical activity, when touched. Atypical occurs at rest, in the absence of treatment it increases.
Pain in the face is accompanied by headaches, general weakness.

Muscle spasms are manifested in difficulty in speaking, chewing, that is, when opening the mouth and moving the jaws. Convulsions, facial asymmetry are observed.This is especially noticeable when talking or smiling.

Skin numbness or, conversely, increased sensitivity appears on the affected part of the face.

In case of numbness, sensitivity disappears in a certain area, which can pass to the lips.

In the second case, any, even minor, contact with the skin causes pain.

Neuralgia is accompanied by a number of concomitant, secondary symptoms:

taste distortion;
profuse salivation, lacrimation;

90,046 temperature rise;

anxiety, insomnia;
skin flushing
edema of the affected part of the face.

Fading is common in patients with trigeminal inflammation. They try not to move so as not to provoke an attack of pain.

Complications

If treatment is not started at the first signs of the disease, neuralgia gives multiple complications:

Chronic, persistent head and facial pains;
Partial paralysis of the facial nerve, which will lead to facial asymmetry, wrinkles, weakening and sagging of the muscles;
Disturbance in the work of the nervous system, expressed by anxiety, sleep disturbance, depression;
atrophy of the skin and mucous membranes;
decreased vision and hearing;
decreased immunity.

Due to the complications that have arisen, the quality of human life decreases. Severe soreness and distortion of appearance lead to limited communication with other people.

Frequent illnesses weaken the body and cause chronic illnesses. Fatigue increases, performance decreases.

Constant pain and forced rejection of the usual way of life, restrictions on nutrition and communication lead to changes in the human psyche.

Prevention

Inflammation of the trigeminal nerve is a disease requiring complex treatment, in the absence of which serious complications arise.

Simple preventive measures will help you avoid this trouble. This requires the prevention of factors leading to neuralgia:

avoid drafts;
to prevent hypothermia of the face;
to strengthen the immune system;
Protect from injuries to the face and head;
Treat dental and infectious diseases at the first symptoms;
timely eliminate stress, psycho-emotional stress;
give up bad habits, alcohol abuse.

The same recommendations help to reduce the intensity of pain in inflammation of the trigeminal nerve.

Inflammation of the occipital nerve

Inflammation of the occipital nerve (neuralgia of the occipital nerve) is a neurological disease, which is based on the mechanism of entrapment of the roots of the occipital nerves. The occipital nerves – large and small – are located in the region of the second cervical vertebra and are responsible for the innervation of organs and tissues located in this area.

The main symptom of occipital neuralgia is excruciating, exhausting pain in the head and neck.Pain is often accompanied by nausea and can cause fainting. The pain has a shooting character and is accompanied by pulsating impulses, most often localized in one half of the head or in the occipital region. The pain intensifies from exposure to light, noise, when tilting or turning the head, when touching the scalp and neck, especially when certain points are pressed – the so-called trigger zones. Painful sensations force you to hold your head in a certain position and avoid movement. Patients note a decrease in the sensitivity of the occiput and ears, a feeling of numbness, crawling “goose bumps”.In general, the symptoms are quite similar to a migraine attack.

What causes can cause inflammation of the occipital nerve? These are:

hypothermia. This is a disease of those who do not wear a hat in cold weather or who are in a stream of cold air from an air conditioner for a long time.
Osteochondrosis of the cervical spine
Injury of the spine or muscles in the neck
Muscle spasm. Typical for people leading a sedentary lifestyle
problems with posture, curvature of the spine
stress
complications after previous viral diseases
diseases such as multiple sclerosis, gout, diabetes mellitus, encephalitis, meningitis, lupus erythematosus
intoxication, in particular alcohol.

At the first sign of occipital neuralgia, you should consult a neurologist. The pain syndrome is so strong that it can deprive you of working capacity and on your own, with folk remedies or advice from the Internet, you cannot solve the problem.

On the contrary, a neurologist with professional qualifications and experience, to establish the correct diagnosis and prescribe a comprehensive treatment, including drug therapy, advanced physiotherapy using advanced equipment.