Trigeminal Neuralgia

Long-term pain disorder that affects the trigeminal nerve

Aetiology

  • More common in elderly (>60 years) women
  • Attacks may be brought on by stimulation of one or more trigger zones in the face
    • Washing, shaving, a cold wind and chewing are examples of trivial stimuli that provoke pain

Pathophysiology

  • Cause is unclear but it is thought to be caused by compression of the nerve

Clinical presentation

  • Severe stabbing unilateral stabbing facial pain - occurs in the distribution of CN V
  • Attacks last 1-90 secs
  • Episodes occur many times a day with a refractory period after each
  • Bouts of pain may last weeks-months
  • Spontaneous remissions last months or years before (almost invariable) recurrence

Investigations

  • MRI brain

Management

  • Medical - carbamazepine first line, gabapentin, phenytoin
  • Surgical - ablation, decompression