Trigeminal neuralgia

16th October 2014 by NASGP

Trigeminal neuralgia

Although rare, trigeminal neuralgia can have a huge impact on a patient’s quality of life. This useful BMJ review gives us guidance on how to spot it and treat it effectively, something your patients with trigeminal neuralgia will no doubt thank you for! (BMJ 2014;348:g474).

What is trigeminal neuralgia?

  • A facial pain syndrome which usually presents with episodic, unilateral electric shock-like facial pain in the two lower branches of the trigeminal nerve.
  • It is most common between 50-60 years of age and commoner in men than women.
  • Most cases (95%) are classed as idiopathic and may relate to vascular compression of the trigeminal nerve by a blood vessel.
  • The remaining 5% are associated with abnormalities such as a brain tumour, vascular abnormality or multiple sclerosis.

Diagnosis

This is usually clinical, imaging is only required if there are red flags or atypical features.

Typical features of pain Red flags/atypical features
Unilateral, electric shock-likeAffects lower two branches of trigeminal nerveEpisodic and sudden onsetNo pain between attacksAttacks gradually become closer togetherProvoked by light touch, eating, cold winds, vibration Occurrence <40 years ageBilateral symptomsOphthalmic division only affectedSensory lossHearing lossSkin or oral lesionsNo response to treatment

If the diagnosis can be made clinically, start treatment in primary care. If red flags/atypical features are present, refer for neurological assessment and possible MRI.

Medical treatment

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