Trigeminal Neuralgia & Trigeminal Autonomic Cephalalgias Flashcards
What is neuralgia?
- intense stabbing pain (brief but intense)
- extends along the course of the affected nerve
- usually caused by irritation or damage to a nerve
What are some causes of trigeminal neuralgia?
- idiopathic (no cause)
- classical
- secondary
What is classical trigeminal neuralgia?
vascular compression of the trigeminal nerve
What are secondary causes of trigeminal neuralgia?
- multiple sclerosis
- space-occupying lesion
- skull base bone deformity
- arteriovenous malformation
how does trigeminal neuralgia present?
- unilateral maxillary or mandibular devision pain
- stabbing pain
- 5-10 seconds duration (can be on its own or in clusters)
What are some potential triggers for trigeminal neuralgia?
- cutaneous
- wind, cold
- touch
- chewing
what is your typical trigeminal neuralgia patient?
- usually older
- ‘mask-like’ face
- appearance of excruciating pain
- NO obvious precipitating pathology
What are some red flags in trigeminal neuralgia patients that may suggest something else is going on?
- younger patient (<40)
- sensory deficit in facial region (eg hearing loss)
- other cranial nerve lesions
What are first line drugs for trigeminal neuralgia treatment?
- carbamazepine
- oxcarbazepine
- lamotrigine (slow onset of action)
What second line drugs are used to treat trigeminal neuralgia?
- gabapentin
- pregabalin
- phytoin baclofen
If a patient is having a trigeminal neuralgia attack in the chair, what can you do to help?
give local anaesthetic
What side effects result from carbamazepine?
- thrombocytopenia or neutropenia or pancytopenia
- electrolyte imbalances
- paraesthesia
- liver toxicity
- skin reactions
When should you consider surgery for trigeminal neuralgia management?
- when approaching maximum tolerable medical management even if pain controlled
- younger patients with significant drug use
What surgical options are available for trigeminal neuralgia treatment?
- microvascular decompression
- destructive central procedures
- stereotactic radiosurgery
- destructive peripheral neurectomies
what complications may arise from trigeminal neuralgia surgery?
- sensory loss (corneal reflex, general sensation, hearing loss)
- motor deficits
What are other causes of painful trigeminal neuropathy aside from trigeminal neuralgia?
- herpes zoster virus
- trauma
- idiopathic
What are characteristics of painful trigeminal neuropathy that is not trigeminal neuralgia?
- pain is localised to trigeminal distribution
- burning or squeezing or pins & needles
- pain is continuous or near continuous
- usually accompanied by clinically evident cutaneous allodynia
what are the features of cephalalgic trigeminal neuralgia?
- unilateral head pain (v1)
- very severe/excrutiating
- prominent cranal parasympathetic aytonomic features
What are examples of autonomic cephalalgic trigeminal neuralgia?
- cluster headache proxysmal
- paroxysmal hemicrania
Where is the pain usually located in cluster headaches?
mainly orbital & temporal
How do cluster headaches typically present?
- attacks are strictly unilateral
- rapid onset
- last 15 mins to 3 hours (majority are 45-90 mins)
- rapid cessation of pain
How do cluster headache episodes present?
- attacks cluster in bouts typically 1-3 months with headaches & then 1 month remission
- attack frequently
- may have continuous background pain during a bout of attacks
Where is the pain found in paroxysmal hemicrania?
- mainly orbital and temporal
How does paroxysmal hemicrania differ from cluster headaches?
- last 2-30 mins
- 2 - 40 attacks per day
- 10% of attacks may be precipitated by bending or rotating their head
- 80% haft chronic PH
