What is the relationship between postnasal drip and trigeminal neuralgia?

From the Guidelines

Post nasal drip and trigeminal neuralgia are not directly related conditions, but they can coexist and potentially exacerbate each other. For post nasal drip, treatment options include saline nasal sprays, antihistamines like loratadine (10mg daily) or cetirizine (10mg daily), nasal steroid sprays such as fluticasone (1-2 sprays per nostril daily), and mucus thinners like guaifenesin (400mg every 4 hours as needed) 1. For trigeminal neuralgia, first-line medication is typically carbamazepine (starting at 100mg twice daily, gradually increasing to 200-400mg twice daily as needed) or oxcarbazepine (starting at 150mg twice daily, increasing gradually) 1. Other options include gabapentin (300mg daily, increasing to 300-600mg three times daily) or pregabalin (75mg twice daily, increasing as needed) 1. If post nasal drip causes sinus congestion or inflammation, this could potentially trigger or worsen trigeminal neuralgia pain in susceptible individuals due to pressure on nearby nerve structures. Managing the post nasal drip effectively with the medications mentioned, along with staying hydrated, using a humidifier, and elevating the head while sleeping, may help reduce potential triggers for trigeminal neuralgia. However, both conditions should be evaluated by appropriate specialists as they may require different treatment approaches and could be symptoms of other underlying conditions. It is also important to note that facial pain without other nasal complaints or abnormalities on examination should not be addressed surgically, and a pragmatic approach to the patient with facial pain is provided 1. In cases where first-line treatment for trigeminal neuralgia fails, it is advised to consult a specialized neurologist dedicated to neuropathies, headache, and facial pain 1.

Some key points to consider in the management of these conditions include:

• The use of disease-specific surveys such as the SNOT-22 to help discern sinonasal facial pain from other causes 1
• The importance of a careful history and physical examination in diagnosing post nasal drip and trigeminal neuralgia
• The potential for post nasal drip to exacerbate trigeminal neuralgia pain, and the need for effective management of both conditions to improve quality of life. It is essential to prioritize the management of both conditions to minimize morbidity, mortality, and improve the quality of life for patients with post nasal drip and trigeminal neuralgia.

From the Research

Trigeminal Neuralgia and Post Nasal Drip

• There is no direct evidence in the provided studies that links post nasal drip to trigeminal neuralgia 2, 3, 4, 5, 6.
• Trigeminal neuralgia is a highly disabling disorder characterized by severe, brief, and electric shock-like recurrent episodes of facial pain 2.
• The treatment for trigeminal neuralgia includes medical therapy with anticonvulsant drugs such as carbamazepine and oxcarbazepine, as well as surgical options like microvascular decompression 2, 3, 5.
• Some studies suggest that combination therapy may be the optimal approach for treating trigeminal neuralgia, allowing for lower doses of carbamazepine or oxcarbazepine and reducing potential adverse events 4.
• Other forms of neuropathic pain, such as glossopharyngeal neuralgia, trigeminal neuropathic pain, and burning mouth syndrome, require recognition and a different management approach 6.

Treatment Options for Trigeminal Neuralgia

• Medical therapy:
  • Anticonvulsant drugs: carbamazepine, oxcarbazepine, lamotrigine, gabapentin, pregabalin 2, 3, 4, 6
  • Other drugs: baclofen, botulinum toxin type A, baclofen 2, 6
• Surgical options:
  • Microvascular decompression 2, 3, 5
  • Percutaneous methodologies: glycerol or radiofrequency ablation 5
  • Radiosurgery 5
  • Peripheral neurectomies 5