Trigeminal Neuralgia: Understanding the Causes Behind the "Suicidal Disease of the Face"

Trigeminal neuralgia, often referred to as the "suicidal disease of the face" due to its intense pain, is considered one of the most excruciating forms of headache. The condition can be categorized into two main types based on its underlying mechanisms: classical (idiopathic) and secondary trigeminal neuralgia.

Classical Trigeminal Neuralgia

While the exact cause of classical trigeminal neuralgia remains unknown, medical experts believe it often results from neurovascular compression. In many cases, small blood vessels exert pressure on the trigeminal nerve, causing abnormal signal transmission. This compression leads to sudden, shock-like facial pain that can be triggered by simple activities like talking, eating, or brushing teeth.

Secondary Trigeminal Neuralgia

Secondary trigeminal neuralgia develops as a consequence of structural damage or disease. One of the primary causes includes tumor-related compression, particularly in the cerebellopontine angle area where tumors can directly press on the trigeminal nerve. This type typically causes constant, burning pain rather than the intermittent sharp pains associated with classical cases.

Other Contributing Factors

In addition to tumors, certain viral infections can also trigger this condition. The first branch of the trigeminal nerve is particularly susceptible to herpes zoster infection, which can lead to post-herpetic neuralgia. This complication often results in prolonged facial pain following a shingles outbreak.

Key Diagnostic Differentiators

A crucial distinction between the two types lies in sensory function assessment. Patients with classical trigeminal neuralgia typically experience heightened sensitivity (allodynia) on the affected side. Conversely, those suffering from secondary forms usually demonstrate reduced facial sensation during neurological examination, indicating potential nerve damage from underlying structural issues.