Trigeminal Neuralgia

Question 1

What is trigeminal neuralgia?

Answer 1

A chronic pain disorder that affects the trigeminal nerve (CrN5). There are two main types: typical and atypical trigeminal neuralgia. The typical form results in episodes of severe, sudden, shock-like pain in one side of the face that lasts for seconds to a few minutes

Question 2

What is thought to be the cause of trigeminal neuralgia?

Answer 2

Compression of the trigeminal nerve at or near the pons by an ectatic vascular loop is the usual cause

Question 3

What is the main risk factor for development of trigeminal neuralgia?

Answer 3

Hypertension

Question 4

What are features of trigeminal neuralgia?

Answer 4

• Paroxysms of intense pain, lasting seonds, in trigeminal distribution:
  
  • Maxillary
  • Mandibular

Question 5

What are triggers of trigeminal neuralgia?

Answer 5

• Washing face
• Shaving
• Eating
• Talking

Question 6

What sex does trigeminal nerualgia occur more commonly in?

Answer 6

Female

Question 7

What are secondary causes of trigeminal neuralgia?

Answer 7

• Anomylous intracranial vessels
• Tumour
• Chronic meningeal inflammation
• MS
• V. Zoster
• Skull base malformation

Question 8

What investigations would you perform if you suspected trigeminal neuralgia?

Answer 8

MRI - look for secondary cause

Question 9

What medical treatments could you use to manage trigeminal neuralgia?

Answer 9

• First line - Carbemazapine (within 3 days of onset)
• Second line - Gabapentin/Pregabalin/Amitriptyline
• Baclofen

Question 10

What surgical options are available for refractory trigeminal neuralgia?

Answer 10

• Microvascular decompression
• Ablative rugical procedures

Question 11

What are the risks with ablative surgical procedures for treating trigeminal neuralgia?

Answer 11

Destroy facial sensation in distribution of nerve ablated - however does stop pain