Headache: Trigeminal neuralgia

Question 1

Defintion

Answer 1

Chronic facial pain syndrome in one or more of the Trigeminal branches.
Unilateral pain in 1< trigeminal branches

Question 2

Risk factors

Answer 2

Multiple sclerosis
Increasing age
Female

Question 3

Triggers

Answer 3

Eating
Shaving
Talking
Brushing teeth

Question 4

Symptoms

Answer 4

Electric shock pain (seconds - 2 mins) in V1/2/3
Unilateral
Provoked by touch or cold
Some patients experience autonomic symptoms such as:
- lacrimation,
- facial swelling,
- rhinorrhoea
- ptosis

Question 5

Diagnosis

Answer 5

Clinical
- 3+ with above symptoms
MRI may be considered

Question 6

Diagnostic Criteria

Answer 6

International classification of headache disorders (ICHD-3);
A: Pain lasting seconds to 2 mins + severe intensity + electric/shooting/stabbing/sharp character
B: Precipitated by innocuous stimuli, within affected Trigeminal distribution
C: not better explained by another ICHD-3 condition

Question 7

Treatment

Answer 7

FIRST LINE = CARBEMAZAPINE
SECOND LINE = LAMOTRIGINE or GABAPENTIN

Question 8

Red flag symptoms

Answer 8

Age of onset before 40 years
Pain only in the ophthalmic division (eye socket, forehead, and nose), or bilaterally
Sensory changes
Deafness or other ear problems
History of skin or oral lesions that could spread perineurally
Optic neuritis
Family history of multiple sclerosis