A neuropathic disorder of the trigeminal nerve that causes episodes of intense pain.
Also known as Tic Douloureux
Many cases are associated with vascular compression and subsequent demyelination of the trigeminal nerve, though other causes include compression by a tumor, and multiple sclerosis.
Classic Trigeminal Neuralgia is a clinical diagnosis that has the following criteria:
Paroxysmal attacks of pain lasting from a fraction of a second to two minutes that affect one or more divisions of the trigeminal nerve
Pain has at least one of the following characteristics: intense, sharp, superficial, or stabbing precipitated from trigger areas or by trigger factors
Attacks are similar in individual patients
No neurological deficit is clinically evident
Not attributed to another disorder
Treatment options include:
Medical:
Carbamazepine (most common and drug of choice)
Gabapentin (lacks evidence in trigeminal neuralgia but widely used for other neuropathic pain)
Lamotrigine
Baclofen
Surgical:
Microvascular decompression: posterior fossa is explored and the culprit blood vessel is moved off the trigeminal nerve. Typically the nerve is padded with a teflon sheet in order to provide additional protection. 80-90% successful with little or no facial numbness.
Ablative: Attempts are made to just incapacitate the pain fibers but these techniques can result in facial numbness as other sensory fibers can be damaged.Common methods include:
Glycerol or alcohol injection
Radiofrequency rhizotomies
Stereotactic radiation therapy
Complete severing of the nerve.
References
Wikipedia contributors. Trigeminal neuralgia. Wikipedia, The Free Encyclopedia. February 20, 2008, 22:44 UTC. Available at: http://en.wikipedia.org/w/index.php?title=Trigeminal_neuralgia&oldid=192904693. Accessed March 8, 2008
Luke Bennetto, Nikunj K Patel and Geraint Fuller. Trigeminal neuralgia and its management. BMJ 2007;334;201-205
