Version 2.0 Trigeminal Neuralgia 11/05/2012
Synonyms: Tic Douloureux
Introduction
Chronic, debilitating condition of trigeminal nerve (usually maxillary or mandibular divisions)
→ in sporadic & sudden episodes of sev facial pain ("electric shock") lasting secs to mins.
Epidemiology
• Annual incidence ~5-25/100,000 • May also be a genetic predisposition.
• Usually episodes occur >40yrs • 2-4% of patients will have MS
• F>M
Aetiology
• Compression: blood vessels may press on the Vn as it exits the brainstem at its
cerebellopontine nerve root leading to demyelination.
• Degeneration: ageing brain atrophy leads to compression by redundant arterial loops
• Myelin sheath infiltration e.g. tumour or amyloidosis
• Idiopathic
Presentation
• Possible triggers:
o Vibration o Oral intake
o Skin contact e.g. shaving, washing o Exposure to wind
o Brushing teeth
• There may be preceding symptoms e.g. tingling or numbness
• Severe, shock-like unilat (5% bilat) facial pains (may involve eyes, lips, nose & scalp)
• Intermittent but can last days-months and then not return for months-years
Atypical trigeminal neuralgia
Relentless underlying burning pain like a migraine assoc with superimposed stabbing pains.
Investigations
Norm clinical diagnosis. MRI – may show compressive src or other causes (e.g. aneurysm, MS).
Management
Support and education
• Education as to the causes and potential therapies. Reassurance and support groups
Medical
• Anticonvulsants e.g. carbamazepine, gabapentin, phenytoin. May be enhanced with
baclofen and clonazepam - however, the efficacy is not well established.
• Typical analgesics and opioid analgesics unfortunately not very successful
• Tricyclic antidepressants e.g. low dose amitriptyline – supportive evidence is lacking
Surgery (~75% success rates)
Options: decompression procedures or rhizotomy (damage nerve to stop pain transmission).
Complementary therapies - no supporting evidence
• TENS, Acupuncture, Biofeedback, Vitamin therapies e.g. vitamin B, Dietary e.g. garlic
Prognosis
• 33% mild symptoms
• Some have only 1 episode, most have a progressive chronic course.
Synonyms: Tic Douloureux
Introduction
Chronic, debilitating condition of trigeminal nerve (usually maxillary or mandibular divisions)
→ in sporadic & sudden episodes of sev facial pain ("electric shock") lasting secs to mins.
Epidemiology
• Annual incidence ~5-25/100,000 • May also be a genetic predisposition.
• Usually episodes occur >40yrs • 2-4% of patients will have MS
• F>M
Aetiology
• Compression: blood vessels may press on the Vn as it exits the brainstem at its
cerebellopontine nerve root leading to demyelination.
• Degeneration: ageing brain atrophy leads to compression by redundant arterial loops
• Myelin sheath infiltration e.g. tumour or amyloidosis
• Idiopathic
Presentation
• Possible triggers:
o Vibration o Oral intake
o Skin contact e.g. shaving, washing o Exposure to wind
o Brushing teeth
• There may be preceding symptoms e.g. tingling or numbness
• Severe, shock-like unilat (5% bilat) facial pains (may involve eyes, lips, nose & scalp)
• Intermittent but can last days-months and then not return for months-years
Atypical trigeminal neuralgia
Relentless underlying burning pain like a migraine assoc with superimposed stabbing pains.
Investigations
Norm clinical diagnosis. MRI – may show compressive src or other causes (e.g. aneurysm, MS).
Management
Support and education
• Education as to the causes and potential therapies. Reassurance and support groups
Medical
• Anticonvulsants e.g. carbamazepine, gabapentin, phenytoin. May be enhanced with
baclofen and clonazepam - however, the efficacy is not well established.
• Typical analgesics and opioid analgesics unfortunately not very successful
• Tricyclic antidepressants e.g. low dose amitriptyline – supportive evidence is lacking
Surgery (~75% success rates)
Options: decompression procedures or rhizotomy (damage nerve to stop pain transmission).
Complementary therapies - no supporting evidence
• TENS, Acupuncture, Biofeedback, Vitamin therapies e.g. vitamin B, Dietary e.g. garlic
Prognosis
• 33% mild symptoms
• Some have only 1 episode, most have a progressive chronic course.
