Trigeminal Neuralgia

Question 1

Describe the presentation of trigeminal neuralgia

Answer 1

Unilateral maxillary or mandibular div short stabbing pain

Lasts 5-10 seconds

Question 2

Causes of trigeminal neuralgia

Answer 2

1. Idiopathic
2. Classical
   - Vascular compression of the trigeminal nerve
3. Secondary
   - MS
   - Space occupying lesion

Question 3

Triggers for trigeminal neuralgia

Answer 3

• Cutaneous
• Wind/cold
• Chewing
• Touch

Question 4

Age affected by trigeminal neuralgia usually

Answer 4

40+

Question 5

Red flags for trigeminal neuralgia

Answer 5

Younger patients

Sensory deficit in facial region - hearing loss

Question 6

First line tx for TN

Answer 6

Carbamezipine 100mg 1 tablet 2x daily

Question 7

Second line

Answer 7

Gabapentin

Question 8

Side effects of Carbamazepine

Answer 8

Thrombocytopenia
Neutropenia
Electrolyte imbalances
Paraesthesia
Liver toxicity

Question 9

Surgery indications for TN (2)

Answer 9

• When approaching max tolerable medical management even if pain controlled
• Pts with significant drug use

Question 10

Surgery options for TN (3)

Answer 10

• Microvascular decompression
• Destructive central procedure
• Stereotactic radiosurgery

Question 11

Triggers for cluster headache

Answer 11

Alcohol when in bout but not in remission

Question 12

Features of a Paroxysmal Hemicrania

Answer 12

1-40 attacks daily
Last 2-30mins
Sharp throbbing v severe unilateral pain
Orbital + temporal region

Question 13

Features of a cluster headache

Answer 13

1-8 attacks daily
Last 15 mins -3hrs
Sharp throbbing v severe unilateral pain
Orbital + temporal region