Treatment of Neuralgia
The trigeminal nerve is a cranial nerve, which is responsible for innervating the face, tongue, something from the ear, and the eye. The nerve leaves the brainstem and after crossing the skull on the inside reaches the Gasser ganglion, from where it will be divided into three branches or nerves: mandibular, maxillary and ophthalmic. These three nerves will take care of the sensory and motor part of certain parts of those previously mentioned. Although not acting alone since the facial nerve, is also very involved in the innervation of facial structures.
According to the International Headache Society (IHS) trigeminal neuralgia can have three origins: derived from a viral infection by the Varicella-Zoster virus or a structural anomaly of the nerve itself (eg by a multiple sclerosis plaque), in which case it would be called neuralgia secondary to the cause that produces it, or in the third case when there is no apparent cause, called idiopathic.
The term Classical Neuralgia is reserved for those patients in whom there is compression of the trigeminal nerve at the vascular level, this lesion being located by resonance and treated surgically.
Regarding the symptomatology of the patient with Neuralgia, the fundamental characteristics that the patient must present are:
- The pain lasts from a fraction of a second to two minutes
- The intensity of the pain is severe.
- The pain is similar to an electric shock, a shot, a stab or very sharp quality
- The pain appears by innocuous stimuli, which usually do not cause pain and within the distribution of the affected nerve.
As it is deduced by the previous lines, the normal thing is to have affected one branch of the trigeminal while the others do not present symptomatology. On rare occasions, or when the patient has been without treatment for a long time, or with ineffective treatments, the attacks may last more than 2 minutes. And finally, the patient can provoke attacks because he knows the proper maneuver to reproduce it.
As we have said before, there is a type of neuralgia, caused by the structural compression of the nerve, in addition there are several pharmacological treatments that have a very high effectiveness in the treatment of this pathology.
But what can physiotherapy do in trigeminal neuralgia? Any pathology that generates associated painful symptoms and prolonged over time, generates a series of changes at the central level in what we will call the centers in charge of pain processing. One of those changes that are generated are called central sensitization, and assume that our brain becomes a loudspeaker, which amplifies everything that arrives in the form of a nociceptive impulse that will be the one that after processing it in the brain becomes a stimulus painful.
In general, this sensitization situation also occurs in the peripheral tissues, in this case in the cervical and facial musculature, so that it is easier for any stimulus to trigger pain. Physiotherapy using different techniques such as mobilization of peripheral nervous tissue, in this case the trigeminal mandibular nerve, dry puncture on the facial and cervical musculature or mobilization of the mandibular complex has been shown to be effective in the treatment of these pathologies.
Finally, associated with pain permanently or prolonged, there is a loss of mandibular motor control, which through a program of exercises that are learned in clinic for the daily realization at home, we get to restore ..
Treatment of mandibular alterations that occur with pain or difficulty in movement (inability to open the mouth).
Manual therapy on the cranio-cervico-mandibular complex that returns a normal movement to the area to try to reduce the pain and restore the correct functioning.
Cervical Column Treatment
Treatments of the cervical spine, which in general is related to most of the painful processes of the head, mouth and neck.
Physiotherapy in Maxillofacial Surgery
Pre and post-surgical treatments in maxillofacial surgery, which helps us to reduce the deadlines and the consequences of the intervention.
Treatment of Headaches and Migraines
Specific treatment of headaches and migraines, based on a correct diagnosis based on the current clinical guidelines of the International Headache Society.