Trigeminal neuralgia

Question 1

What is trigeminal neuralgia?

Answer 1

Trigeminal neuralgia is a pain syndrome characterised by severe unilateral pain.

Question 2

What are the common causes of trigeminal neuralgia?

Answer 2

The vast majority of cases are idiopathic, but compression of the trigeminal roots by tumours or vascular problems may occur.

Question 3

How does the International Headache Society define trigeminal neuralgia?

Answer 3

It is defined as a unilateral disorder characterised by brief electric shock-like pains, abrupt in onset and termination, limited to one or more divisions of the trigeminal nerve.

Question 4

What are common trigger factors for trigeminal neuralgia pain?

Answer 4

The pain is commonly evoked by light touch, including washing, shaving, smoking, talking, and brushing the teeth.

Question 5

What are trigger areas for trigeminal neuralgia pain?

Answer 5

Small areas in the nasolabial fold or chin may be particularly susceptible to the precipitation of pain.

Question 6

How does the pain in trigeminal neuralgia typically behave?

Answer 6

The pains usually remit for variable periods.

Question 7

What are red flag symptoms suggesting a serious underlying cause of trigeminal neuralgia?

Answer 7

Red flag symptoms include sensory changes, deafness or other ear problems, history of skin or oral lesions that could spread perineurally, pain only in the ophthalmic division, optic neuritis, a family history of multiple sclerosis, and age of onset before 40 years.

Question 8

What is the first-line treatment for trigeminal neuralgia?

Answer 8

Carbamazepine is first-line treatment.

Question 9

What should be done if a patient fails to respond to treatment for trigeminal neuralgia?

Answer 9

Failure to respond to treatment or atypical features should prompt referral to neurology.