Trigeminal neuralgia

Question 1

What is trigeminal neuralgia

Answer 1

severe disabling condition characterised by painful episodes of sudden sharp stabbing pain in region of trigeminal nerve distribution

Question 2

What is the epidemiology of trigeminal neuralgia

Answer 2

occurs more often in women
typical age of onset is 60-70 years old

Question 3

How may someone with trigeminal neuralgia present

Answer 3

unilateral stabbing sharp facial pain
- involving one or more divisions of trigeminal nerve
-lasts seconds
- triggered by eating , laughing ,talking or touching affected area

Question 4

What usually causes trigeminal neuralgia

Answer 4

secondary to nerve compression by arteries or veins

in number of small cases - secondary to compression by tumour or arteriovenous malformation

Question 5

What are risk factors for trigeminal neuralgia

Answer 5

increased age
female
Multiple sclerosis

Question 6

How do you make a diagnosis of trigeminal neuralgia

Answer 6

-clinical diagnosis

MRI can help exclude secondary causes

trigeminal reflex testing after diagnosis

Question 7

What is first line management

Answer 7

CARBAMAZEPINE -
an anticonvulsant

refer to neurology if respond to treatment or atypical features

Question 8

What are red flag symptoms

Answer 8

sensory changes
deafness/ other ear problems
history of skin/oral lesions
pain only in opthalmic division or bilateral
optic neuritis
family history of MS
age of onset before 40