Face lightning pain

Introduction Many people often feel that a part of the body "lightning" is generally a quick sting. But because the pain is very short and does not attract people's attention, "lightning" pain is also one of the main symptoms of neuralgia. This "lightning" type of pain may be neuropathic pain. Facial lightning pain is caused by trigeminal neuralgia and is a neurological disease characterized by transient recurrent severe pain in the facial trigeminal nerve distribution area.

Cause

The etiology and pathogenesis of primary trigeminal neuralgia are unclear, but most of the lesions are thought to be around the trigeminal nerve, that is, within the sensory root of the trigeminal semilunar. According to microsurgery and electron microscopy, it may be related to factors such as small vessel malformation and bone deformity in the rock bone, which may cause pain.

1. Classification by cause: According to whether the cause is clear, it is divided into primary trigeminal neuralgia and secondary trigeminal neuralgia.

(1) Primary trigeminal neuralgia (Idiopathic trigeminal neuralgia): The trigeminal neuralgia that cannot find the exact cause is called "primary trigeminal neuralgia" clinically. In the past, it was considered that most of the clinical cases were transient severe pains in the area of the trigeminal nerve distribution, and it was a disease that could be found without organic damage. More common in middle-aged and older people over the age of 40, up to 70% to 80%, the minimum age is only a teenager, the highest age is 92 years old. The incidence ratio of male and female is different. According to a report of 1454 cases in 15 domestic hospitals, there are more males than females, including 788 males and 666 females. Another group of 4386 cases of trigeminal neuralgia occurred in China, with more women than men, 3:2.

(2) Secondary trigeminal neuralgia (symptomatic trigeminal neuralgia): refers to trigeminal neuralgia caused by secondary damage to the trigeminal nerve caused by various organic lesions inside and outside the brain. More common in patients under the age of 40. The difference with primary trigeminal neuralgia is that the pain attack time is usually longer, or it is persistent, paroxysmal pain, and there is no trigger point. Physical examination can detect the objective manifestations of trigeminal involvement and the signs of primary disease, but it can also be completely negative. CT, MRI examination can generally confirm the diagnosis.

an examination

Related inspection

Facial nerve examination facial nerve examination head and face palpation

Sudden onset, it can be tearing, electrocautery, knife cutting or acupuncture; etc.; each attack time suddenly stops from a few seconds to one or two minutes, more than half an hour; no pain during the interval The course of the disease can be periodic.

(1) Pain area: does not exceed the trigeminal innervation range, often limited to one side. Although all three can be involved, the second and third are the most affected, accounting for 95%.

(2) The nature of the pain: a paroxysmal electric shock, a knife cut and a tear-like pain, sudden sudden stop. Pain starts from the maxillofacial region or alveolar space and radiates along the innervation area. Each pain lasts for a few seconds to tens of seconds, and can last for several minutes. Attacks often change with the prolongation of the course of the disease, shorten the interval and increase the pain. Frequent attacks can affect eating and rest.

(3) Inducing factors and trigger point: Pain attacks often involve casual movement of the face, chewing, brushing, and washing the face or touching a certain area of the face (such as the lips, nasal passages, upper pupils, underarms, and oral gums). Was induced. These sensitive areas are called "trigger points" or trigger points.

(4) Other symptoms: The attack may be accompanied by ipsilateral muscle twitching, facial flushing, tearing and salivation. This special face is also called painful convulsion. In order to alleviate the pain, the patient often rubs the same side with the hand to relieve the pain (in fact, it does not relieve the pain). Over time, the facial skin becomes rough, thickened and the eyebrows fall off. In order to avoid seizures, patients do not dare to eat, wash their faces, face convulsions, depression and depression.

(5) Signs: objective examination of multiple trigeminal nerve function defects and other localized neurological signs. Occasionally, herpes can occur in the dominating area of one of the branches, which is caused by a half-month ganglion herpes zoster virus infection.

Secondary trigeminal neuralgia refers to pain in the area of the trigeminal nerve caused by various lesions invading the trigeminal nerve root, the semilunar ganglion or the nerve trunk. It is characterized by a long duration of pain, often ranging from a few minutes to tens of minutes, or persistent pain, paroxysmal aggravation. Physical examination revealed loss of sensation, disappearance or allergies in the trigeminal innervation area. The first and third branches were involved. The first one can be affected by corneal reflex, and the third one can be seen with weakness and atrophy of the masticatory muscles. In addition, other positive signs of the primary disease may be associated.

Differential diagnosis

Differential diagnosis of facial lightning pain:

1, painful face convulsions: trigeminal neuralgia, also known as painful convulsions. Sometimes called "face pain", it is easy to be confused with toothache. It is a kind of paroxysmal severe neuropathy that recurs in the facial trigeminal nerve distribution area. Trigeminal neuralgia is one of the common diseases in neurosurgery and one of the internationally recognized intractable diseases. Most trigeminal neuralgia starts at the age of 40, mostly in middle-aged and elderly people, especially in women. The disease is characterized by sudden onset, sudden arrest, lightning-like, knife-like, burning, intractable, and unbearable severe pain in the area of the trigeminal nerve in the head and face.

2. Facial pain: Facial pain refers to pain on one or both sides of the face, or pain at the forehead. This pain can be dull or fluctuating, or it can be a very strong sting. Facial pain or paralysis, generally no life-threatening threat, but the pain is very painful, even if it can hold back the pain, the expression is numb.

Sudden onset, it can be tearing, electrocautery, knife cutting or acupuncture; etc.; each attack time suddenly stops from a few seconds to one or two minutes, more than half an hour; no pain during the interval The course of the disease can be periodic.

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