- Sudden and severe pain of trigeminal neuralgia as a lightning pain in the face.
- "tic doloreux" describes the pain that may be triggered by touch or cold
- Incidence 5 /100,000, Women > Men, Onset often after 60 years of age.
- Bouts lasting weeks, remissions lasting months or years.
- Probably caused by compression of the trigeminal nerve root, close to the pons, by an aberrant arterial or venous loop.
- 1% have involvement of all three nerve branches.
- About 2% of patients with trigeminal neuralgia have multiple sclerosis.
- Dental infection or cracked tooth (well localised to tooth, local swelling and erythema).
- TMJ pain (often bilateral, may radiate around ear neck, limited jaw opening).
- Idiopathic facial pain (often bilateral, outside trigeminal territory, pain continuous & milder.)
- Migraine (aura, severe unilateral, assoc GI upset, photophobia).
- Temporal arteritis (constant pain, jaw claudication, fever, wt loss, tender non pulsatile temporal arts).
- Standard first line treatment is Carbamazepine (NNT 2.6 v placebo) [Evidence Based Neurology].
- 2nd line: if carbamazepine not effective, antidepressants are useful in neuropathic pain (NNT <5) [Bandolier 2008].
- Other drugs including Lamotrigine, Phenytoin, Gabpentin, Oxcarbazine, Topiramate, Baclofen, and Clonazepam.
- For management of chronic pain please see Neuropathic Pain page in the analgesia section.
- Microvascular decompression (surgical).
- Methods producing a partial trigeminal nerve lesion.
- Neurectomy, radiofrequency thermal ablation, balloon compression, glycerol injections, and radiosurgery.