Trigeminal Neuralgia

Question 1

Presentation of Trigeminal neuralgia?

Answer 1

Pain syndrome characterised by severe unilateral pain in the face

commonly evoked by light touch, including washing, shaving, smoking, talking, brushing teeth

Occurs spontaneously

(think of man from first day on GP)

Question 2

NICE Clinical Knowledge Summaries list the following as red flag symptoms and signs suggesting a serious underlying cause:

Answer 2

Sensory changes

Deafness or other ear problems

History of skin or oral lesions that could spread perineurally

Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally

Optic neuritis

A family history of multiple sclerosis

Age of onset before 40 years

Question 3

Management of trigeminal neuralgia

Answer 3

carbamazepine is first-line

failure to respond to treatment or atypical features (e.g. < 50 years old) should prompt referral to neurology