Facial pain syndrome in the distribution of ≥1 divisions of the trigeminal nerve.
Diagnosis is clinical, with a history of paroxysms of sharp, stabbing, intense pain lasting up to 2 minutes.
First-line therapy is medical, to which the majority of patients are partially responsive.
Surgical/ablative therapies are reserved for refractory cases.
Ablative therapies can cause facial sensory loss and are associated with a high recurrence rate; however, they are relatively non-invasive and carry minimal risk of severe morbidity/mortality.
Microvascular decompression has few long-term sequelae and well-established efficacy but has a potential risk of major morbidity.
More research on neurostimulation is needed to define its role in the treatment of trigeminal pain.
Trigeminal neuralgia (TN) is a facial pain syndrome in the distribution of ≥1 divisions of the trigeminal nerve. It is characterised by some combination of paroxysms of sharp, stabbing, intense pain lasting up to 2 minutes and/or a constant component of facial pain, without associated neurological deficit. The pain can be precipitated by trigger areas or factors, and repeat attacks are typically stereotyped in the individual.
History and exam
Key diagnostic factors
- facial pain
- presence of risk factors
Other diagnostic factors
- prior oropharyngeal or facial trauma
- prior herpetic outbreak
- sensory/motor changes
- increased age
- multiple sclerosis
1st investigations to order
- no first test
Investigations to consider
- intra-oral x-ray
- trigeminal reflex testing
newly-diagnosed trigeminal neuralgia (TN)
anticonvulsant-unresponsive trigeminal neuralgia (TN)
medicine-unresponsive trigeminal neuralgia type I (TNI)
medicine-unresponsive trigeminal neuralgia type I/II (TNI/II)
refractory trigeminal neuralgia type I/II (TNI/II) (medical and surgical failures); trigeminal neuropathic pain; trigeminal deafferentation pain; symptomatic TN
Gaetan Moise, MD
Assistant Professor of Neurological Surgery
Columbia University Medical Center
GM declares that he has no competing interests.
Professor Gaetan Moise would like to gratefully acknowledge Professor Christopher J. Winfree, a previous contributor to this monograph. CJW declares that he has no competing interests.
Alon Y. Mogilner, MD, PhD
Section of Functional and Restorative Neurosurgery
North Shore-Long Island Jewish Health System
AYM declares that he has no competing interests.
Richard K. Osenbach, MD
Division of Neurosurgery
Duke University Medical Center
RKO declares that he has no competing interests.
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