Trigeminal Neuralgia

1.Trigeminal Neuralgia tic douloureux


Trigeminal neuralgia is characterized by unilateral, repetitive, unilateral, and excruciating pains confined to the distribution of, typically, the second, but sometimes third, branch of the trigeminal nerve, cranial nerve V. 

-Typically presents in middle or old age.

-It affects women more frequently than men 

Symptoms & Signs 

-TN is typically unilateral. 

-The paroxysms tend to recur frequently 

-The pain exacerbated by touch 

-Frequent, excruciating paroxysms of pain in lips, gums, cheek, or chin lasting seconds to minutes.

-In a patient younger than 40 years presenting with trigeminal neuralgia, multiple sclerosis must be suspected 

-Objective signs of seonory loss cannot be demonstrated on examination 


-The history is key for diagnosis

-Brain MRI if secondary cause is suspected 


Medications: Carbamazepine, Oxcarbazepine, Phenytoin, Baclofen, Topiramate, Lamotrigine, Gabapentin 

Carbamazepine: Carries the risk of agranulocytosis 

Surgery: Microvascular surgical decompression, radiofrequency thermal rhizotomy, gamma knife radiosurgery, peripheral neurectomy 


-Spontaneous remissions may occur for several months or longer

Q.What do you suspect in a young patient with bilateral trigeminal neuralgia? Multiple sclerosis