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Trigeminal neuralgia is a pain syndrome characterized by severe unilateral pain.
The vast majority of cases are idiopathic but compression of the trigeminal roots by tumours or vascular problems may occur.
defention of Trigeminal neuralgia
The International Headache Society defines trigeminal neuralgia as: •
A unilateral disorder characterized by brief electric shock-like pains, abrupt in onset and termination, limited to one or more divisions of the trigeminal nerve •
The pain is commonly evoked by light touch, including washing, shaving, smoking, talking, and brushing the teeth (trigger factors), and frequently occurs spontaneously • Small areas in the nasolabial fold or chin may be particularly susceptible to the precipitation of pain (trigger areas) • The pains usually remit for variable periods
Management of trigeminal
Carbamazepine (Tegretol®) is first-line •
Failure to respond to treatment or atypical features (e.g. < 50 years old) should prompt referral to neurology
2010 NICE neuropathic pain guidelines recommend using amitriptyline or pregabalin first-line for nondiabetic neuropathic pain., but makes no specific recommendation for trigeminal neuralgia. Due to the amount of evidence supporting carbamazepine in trigeminal neuralgia and its recommendation in consensus guidelines (including Clinical Knowledge Summaries)
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