wiki:neurology:trigeminalneuralgia

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
course varies but can last years

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

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

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