Trigeminal Neuralgia

Question 1

Define:

Answer 1

• Neuralgia involving one or more of the branches of the trigeminal nerves, often causing severe pain.

Question 2

Aetiology/risk factors:

Answer 2

• Thought to be due to compression of the trigeminal nerve by a loop of artery or vein

Secondary causes (5-10% of cases)
Compression of the trigeminal root by anomalous or aneurysmal intracranial vessels or a tumour
Chronic meningeal inflammation
MS
Zoster
Skull base malformation

Question 3

Epidemiology:

Answer 3

• Peak incidence: 50-60 yrs
• Prevalence increases with age
• More common in FEMALES (2:1)
• Some familial component

Question 4

Signs and symptoms:

Answer 4

• Sudden, unilateral, brief, stabbing pain in the distribution or one or more branches of the trigeminal nerve
• Recurrent
• Pain lasts from a few seconds to a couple of mins
• Periods of remission can vary
• Some experience preceding symptoms (e.g. numbness, tingling)
• Pain is described as being ‘shock-like’ – face screws up with pain

Question 5

Triggers:

Answer 5

o	Vibration 
o	Skin contact – washing area, shaving
o	Eating
o	Talking 
o	Dental prostheses
o	Brushing teeth 
o	Exposure to wind

Question 6

Investigations:

Answer 6

• Diagnosis is CLINICAL

* MRI is necessary to exclude secondary causes