=====Trigeminal Neuralgia=====
  *thought due to vascular compression of Trigeminal N, most commonly by superior cerebellar & anterior inferior cerebellar arteries, possibly leading to demyelination
  *type 1 and type 2.
    *TN type 1 (TN1) - intense, stabbing pain affecting the mouth, cheek, nose, and/or other areas on one side of the face.
    *TN type 2 (TN2) - less intense pain, but a constant dull aching or burning pain.
  *pain often completely resolves between attacks
  *triggers can include touch, cleaning teeth, cold, wind
  *rare during sleep
  *TN2 tends to be more of an ache but over broader area
  *women>men, age esp >50yrs (rare <40yrs), Right side 5x> Left
  *idiopathic TN - clinical exam should be normal apart from triggering of pain with touch
  *<wrap em> course varies but can last years</wrap>

==Strict criteria for Trigeminal neuralgia as defined by the International Headache Society (IHS) (International Classification of Headache Disorders, 2nd ed) in 2004 are:==

  - Paroxysmal attacks of pain lasting from a fraction of a second to 2 minutes, affecting 1 or more divisions of the trigeminal nerve and fulfilling criteria B and C
  - Pain has at least 1 of the following characteristics: (1) intense, sharp, superficial or stabbing; or (2) precipitated from trigger areas or by trigger factors
  - Attacks stereotyped in the individual patient
  - No clinically evident neurologic deficit
  - Not attributed to another disorder
other classifications do exist but there is no universal agreement

===Management===
  *Carbamazepine 200mg tds-qid usually sufficient
  *Other anti-convulsants prescribed frequently include phenytoin, gabapentin, lamotrigine, oxcarbazepine, and topiramate.
  *Baclofen (GABA derivative muscle relaxant) - alone or in combination with other drugs. The only muscle relaxant with supporting evidence
  *surgery - microvascular decompression

==2019 European Academy of Neurology (EAN) guidelines:==
  *all TN patients should undergo MRI
  *carbamazepine and oxcarbazepine should be used as first-line prophylactic treatments
  *lamotrigine, gabapentin, botulinum toxin type A, pregabalin, baclofen, and phenytoin may be used either alone or as add-on therapy
  *patients should be offered surgery if pain is not sufficiently controlled medically or if medical treatment is poorly tolerated
  *in patients with classical TN, microvascular decompression is recommended as first-line surgery

==References include:==
https://rarediseases.org/rare-diseases/trigeminal-neuralgia/\\ 
https://cks.nice.org.uk/topics/trigeminal-neuralgia/\\ 
[[https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-019-0973-4|prognosis in multidisciplinary Mx program]]\\ 
[[https://emedicine.medscape.com/article/1145144-clinical|Emed Trigeminal neuralgia]]\\ 
[[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3889704/|arterial compression on trigeminal as cause]]\\