From the Guidelines
Trigeminal neuralgia is characterized by sudden, severe, electric shock-like or stabbing pain typically affecting one side of the face in the distribution of the trigeminal nerve, and the primary treatment involves the use of anticonvulsants such as carbamazepine or oxcarbazepine, with surgical interventions considered in cases of intolerable side effects or sub-optimal pain control 1. The pain episodes are usually brief, lasting seconds to minutes, but can occur in clusters throughout the day, and are often triggered by light touch activities such as brushing teeth, washing the face, shaving, eating, drinking, talking, or even exposure to wind. Between painful episodes, patients typically have pain-free periods, and the pain most commonly affects the second and third branches of the trigeminal nerve, involving the cheek, jaw, teeth, gums, and lips. Some patients may experience a constant, aching, burning sensation between attacks, and physical examination is usually normal, with the diagnosis primarily clinical based on the characteristic pain pattern. The condition is caused by compression of the trigeminal nerve, often by a blood vessel, though multiple sclerosis, tumors, or other structural abnormalities can also be responsible, and tends to worsen over time, with pain-free intervals becoming shorter and attacks more frequent and severe if left untreated 1. Key features of trigeminal neuralgia include:
- Sudden, severe, electric shock-like or stabbing pain
- Unilateral pain affecting one side of the face
- Pain distribution in the trigeminal nerve area, commonly affecting the second and third branches
- Brief pain episodes, lasting seconds to minutes
- Pain-free periods between episodes
- Triggers such as light touch, eating, or wind
- Possible constant, aching, burning sensation between attacks
- Normal physical examination
- Clinical diagnosis based on characteristic pain pattern
- Cause often due to compression of the trigeminal nerve by a blood vessel, multiple sclerosis, tumors, or other structural abnormalities. The management of trigeminal neuralgia should prioritize the use of anticonvulsants, with carbamazepine and oxcarbazepine being the primary drugs of choice, and surgical interventions such as microvascular decompression considered in cases of intolerable side effects or sub-optimal pain control, with a chance of being pain-free at 10 years of 70% 1.
From the Research
Trigeminal Neuralgia Symptoms
- Trigeminal neuralgia is characterized by sudden, brief, and excruciating facial pain attacks in one or more of the branches of the trigeminal nerve, leading to a severe reduction in the quality of life of affected patients 2.
- The pain is often described as electric shock-like and can be triggered by light touch or other stimuli 3.
- Trigeminal neuralgia can be classified into idiopathic, classic, and secondary forms, with classic trigeminal neuralgia associated with neurovascular compression in the trigeminal root entry zone 2.
Common Symptoms
- Sudden, severe, and brief episodes of facial pain 2, 3
- Pain can be triggered by light touch, eating, talking, or other stimuli 3
- Pain is often limited to one side of the face, but can occur on both sides in some cases 2
- Pain can be described as electric shock-like, sharp, or stabbing 2, 3
Diagnosis and Treatment
- Diagnosis is often based on clinical presentation and medical history, with MR imaging and high-resolution trigeminal sequences used to confirm the diagnosis 3.
- Treatment options include pharmacological therapy, such as carbamazepine and oxcarbazepine, as well as surgical procedures like microvascular decompression and neuroablative surgical treatments 4, 2, 3, 5, 6.