Trigeminal neuralgia

Question 1

outline the typical presentation of trigeminal neuralgia?

Answer 1

sharp, intense stabbing or burning

can be triggered by common actions-> eating, tooth brushing, cold and touch

shaving and eating

associated with MS

Question 2

define trigeminal neuralgia?

Answer 2

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

Question 3

what are the risk factors for trigeminal neuralgia

Answer 3

increasing age

multipe sclerosis

Question 4

outline the aetiology of trigeminal neuralgia?

Answer 4

compression of trigeminal nerve by loop of artery

secondary causes ( 5-10% of cases)

• compression of trigeminal root by anomalous or aneurysmal intracranial vessels or tumour
• chronic meningeal inflammation
• MS
• Zoster
• skull base malformation

Question 5

summarise the epidemiology of trigeminal neuralgia?

Answer 5

Peak incidence: 50-60 yrs

Prevalence increases with age

More common in FEMALES (2:1)

Some familial component

Question 6

what triggers pain of trigeminal neuraligia?

Answer 6

vibration

skin contact- washing, shaving

eating

talking

dental prostheses

brushing teeth

exposure to wind

Question 7

what are the presenting symptoms and signs of trigeminal neuralgia?

Answer 7

Sudden, unilateral, brief, stabbing pain in the distribution of 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 8

what are the appropriate investigations for trigeminal neuralgia?

Answer 8

diagnosis is CLINICAL

CONSIDER

• MRI to rule out secondary causes
• intra oral x-ray->look for dental cause of pain