Trigeminal neuralgia is a 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 noninvasive 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 characterized 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 neurologic 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
- stereotyped paroxysms of facial pain
- attacks triggered by facial or oral mechanical stimulation
Other diagnostic factors
- sensory/motor changes
- increased age
- multiple sclerosis
1st investigations to order
- no first test
Investigations to consider
- trigeminal reflex testing
- intraoral radiographs
newly diagnosed trigeminal neuralgia (TN)
medication-unresponsive classical trigeminal neuralgia
medication-unresponsive idiopathic trigeminal neuralgia
medication-unresponsive secondary trigeminal neuralgia
- Dental caries
- Dental fracture
- Mandibular osteomyelitis
- ACR Appropriateness Criteria: cranial neuropathy
- ACR Appropriateness Criteria: headache
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