THERAPY AND PROPHYLAXIS OF FACIAL NEURALG IAS AND CHRONIC FACIAL-PAINOF OTHER ORIGIN

Trigeminal neuralgia is a painful affliction of the face characterized by brief electro-shock-like attacks of most intensive pain within the distribution of one or more divisions of the trigeminal nerve. Precip itation by trivial stimuli such as eating, washing, talking is commonl y. Most cases are caused by microvascular compression of the trigemina l root but some other causes such as multiple sclerosis and space-occu pying processes in the posterior cranial fossa have to be excluded. Gl ossopharyngeal neuralgia and N. laryngicus superior neuralgia are rela ted disorders. Prophylactically, anticonvulsant drugs are helpful, pre ferably carbamazepine or phenytoine. Patients who do not respond to me dical treatment should be operated by microvascular decompression of t he nerve or by transcutaneous thermocoagulation of the ganglion resp. glycerol rhizotomy as well. In the differential diagnosis attention ha s to be paid to some other disorders such as cluster headache, posther petic neuralgia, facial pain of central origin, temporomandibular join t disease. Atypical facial pain is characterized by a dull or diffuse unilateral pain in the face, Treatment with a tricyclic antidepressant such as amitriptyline and behavior therapy e.g. progressive relaxatio n may be helpful.