4.9 Trigeminal Neuralgia

Question 1

Define Trigeminal Neuralgia

Answer 1

1. Episodic Neuropathic pain
   Described over distribution of trigeminal nerve
2. A/W spasm muscles mastication
3. Pain
   Unilateral severe paroxysmal
   lancing
   worst ever
4. Can affect all 3 branches
   although mandibular and max
   most common

ophthalmic 3%

5. May develop trigger points and allodynia
   shaving in males

Question 2

Risk factors

Answer 2

1. F;M 2:1
2. Advanced age 60-70
3. HTN
4. MS
   Presenting 20-40 represents BS demyelination

Question 3

Exact aetiology?

Answer 3

Follow trauma?

Current opinion:
Vascular malformation
around trigem ganglion
casues compression demyelination

vs

Central theories focus around abnormal neuros
pons and midbrain
spontaneous fire

Question 4

Diagnosis

Answer 4

Mainly from history

Imaging help exclude brainstem lesion and vascular malformations
COntrast enhanced hi res MRI

Exclusion of alternative aet
Hx suggestive
Post herpetic neuralgia
MS
Atypcai facial pain
TMJ arhtopathy

Question 5

Management

Answer 5

1. Pharmacological Tx

2. Surgical Tx

Question 6

1. Pharmacological Tx

Answer 6

1. Carbamazepine
2. Second line
   Gabapnting