Neurology

Trigeminal neuralgia

Trigeminal neuralgia causes recurrent, brief, severe electric-shock-like facial pain triggered by innocuous stimuli; diagnose the phenotype clinically, investigate atypical or secondary features, offer carbamazepine first-line and refer early when treatment fails or procedures may be needed.

Definition

Trigeminal neuralgia is recurrent, brief, severe electric-shock-like or stabbing pain in one or more trigeminal divisions, usually triggered by innocuous stimuli. It may be classic or secondary to an identifiable structural or demyelinating cause.

First principles

The pain phenotype is the diagnostic anchor

Typical attacks are unilateral, sudden, severe and shock-like, last seconds to about 2 minutes, occur in a trigeminal distribution and are triggered by touch, chewing, talking, brushing teeth or cold air. There may be pain-free intervals and a refractory period. Persistent background pain can coexist, but continuous facial pain without the characteristic paroxysms should prompt reconsideration of the diagnosis.

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