Trigeminal neuralgia

Trigeminal neuralgia is characterized by brief episodes of stabbing pain in the distribution of the trigeminal nerve.

The pain may be triggered by light touch, talking or even a breeze.

It is usually unilateral, with the right side of the face more commonly affected. One or more branches may be implemented in the pain; the most common branch involved is the maxillary and the least common the ophthalmic. Particular ‘trigger points’ can often be identified.

Incidence is 4 per 100000.
Females are slightly more affected than males.
It is rare under the age of 40 – a patient under 40 should prompt investigation for other causes.

The underlying pathophysiology is now believed to be demyelination of the nerve root, classically due to pressure.

First line treatment is carbamezepine. Other options include gabapentin, phenytoin, clonazepam and baclofen. Surgical options include microvascular decompression.

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