Trigeminal neuralgia Flashcards
What Neuralgia?
- intense stabbing pain caused by irritation or damage to a nerve
What 3 nerves can be affected in cranial neuralgia?
- Trigeminal
- Glossopharyngeal and vagus
- Occipital
What is the incidence of trigeminal neuralgia?
More females and elderly
What is the classical cause of trigeminal neuralgia?
Vascular compression of the trigeminal nerve
Trigeminal neuralgia can be secondary to some conditions , give 3 examples?
- Multiple sclerosis
- Space occupying lesion
- AVM
Explain the main symptom of trigeminal neuralgia?
unilateral stabbing pain that may last 5-10 seconds
Which divisions of the trigeminal nerve are mostly affected by trigeminal neuralgia?
- Maxillary and mandibular more affected than opthalmic
List 3 things that may trigger trigeminal neuralgia pain?
- Touch
- Cold and wind
- Chewing
What are the 2 catagories of pain episodes of trigeminal neuralgia?
- Single stabs
- Each attach is a group of stabs
Other than sharp shooting pain , what other two things can this pain have?
- Can affect more than one division and can be bilateral
- Can have a burning component
2 characteristics of a typical trigeminal neuralgia patient?
- Usually older patient
- Mask-like face
What 3 red flags of trigeminal neuralgia?
- younger patient (less than 40)
- other cranial nerves lesions
- sensory deficits in the facial region
What should you do if a patient presents with redflags ?
- Test carnial nerves
- Send patient for an MRI
What class of drugs is trigeminal neuralgia treated with?
Anticonvulsant
What are the 3 first line drugs to manage trigeminal neuralgia?
- Carbamazepine
- Oxcarbazepine
- Lamotrigine
What are 3 second line drugs for trigeminal neuralgia?
- Gabapentin
- Pregabalin
- Phenytoin
When is trigeminal neuralgia more evident during the day?
in the morning
What are 4 side effects of carbamazepine?
- Blood dycrasias
- Electrolyte imbalances
- Neurological deficits
- Paraesthesias
- Liver toxicity
In what 2 cases would you consider surgery for trigeminal neuralgia?
- when approaching maximum tolerable medical management
- in younger patient with significant drug use
What is the preferred surgical treatment for trigeminal neuralgia?
- microvascular decompression
What 3 other surgeries can be carried out to manage trigeminal neuralgia other tham microvascular decompressoin?
- Stereotactic radiosurgery - gamma knife
- Destructive central procedures - balloon compression
- Destructive peripheral neurectomies
What can be 2 risks of complications after surgery?
- Sensory loss - hearing and sensation
- Motor deficits
What group of disorders may be mistaken to be trigeminal neuralgia?
Painful trigeminal neuropathy
What are 3 causes of painful trigeminal neuropathy?
- Herpes Zoster Virus
- Trauma ( pain can develop after 6 months of traumatic event)
- Idiopathic
What are 3 characteristics of painful trigeminal neuropathy?
- Localised pain to one or more parts of the trigeminal nerve
- Describes as pins and needles or burning
- more commonly accompanied by sensory deficits or cutaneous allodynia
- Continuous pain
What is trigeminal autonomic cephalalgias?
Unilateral very severe head pain commonly affecting ophthalmic branch
3 symptoms of trigeminal autonomic cephalalgias other than unilateral head pain?
- Eyelid oedema
- Ear fullness
- Horner’s syndrome (Miosis and ptosis)
These occur ipsilateral to the headache
Give 2 examples of autonomic trigeminal cephalalgias?
- Cluster headache
- Paroxysmal hemicrania
What a cluster headache?
- An autonomic trigeminal cephalalgy affecting the opthalmic division of the trigeminal nerve causing severe unilateral pain in the orbital and temporal region mainly
- Characterised by rapid onset and cessation
How is cluster headache commonly described?
Suicide headache
What can be a differential characteristics between migraines and TACs?
- TAC patient is often restless and agitated during the attack
- Migraine patients have photophobia and phonophobia
How does the cluster headache Episodes present?
they present typically 1-3 months then remission for at least one month
What can trigger a cluster headache during a bout?
Alcohol
What is the key difference between cluster headache and paroxysmal hemicrania?
Cluster headache occur at the same time each day during an episode and an episode occurs at the same time each year
What may trigger a paroxysmal hemicrania?
- bending or rotating the head
Give one attack abortive treatment for cluster headache?
Sumatriptan
What drug can prevent cluster headache?
Topiramate
What drug is used for paroxysmal hemicrania?
indomethacin
