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Trigeminal neuralgia

C K Vasappa MBBS DA FRCA FFPMRCA, S Kapur MBBS MD FRCA FFPMRCA, H Krovvidi MBBS MD FRCA
DOI: http://dx.doi.org/10.1093/bjaed/mkw015 353-356 First published online: 26 April 2016
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Key points

  • Trigeminal neuralgia (TN) is a relatively rare but debilitating facial pain condition.

  • Classical TN occurs without any apparent cause other than possible microvascular compression.

  • TN is a clinical diagnosis, but MRI is helpful to exclude secondary causes.

  • Many patients respond to pharmacological therapy and carbamazepine remains the first-line drug.

  • Microvascular decompression has the best outcome in terms of quality and duration of pain relief.

Trigeminal neuralgia (TN) is a characteristic neuropathic pain involving the trigeminal nerve distribution. The International Association for the Study of Pain (IASP) defines TN as ‘a unilateral painful disorder that is characterised by brief, electric shock like pains, is abrupt in onset and termination, and is limited to the distribution of one or more divisions of the trigeminal nerve’. The annual incidence of TN in the UK is around 26/100 000.1 Worldwide prevalence varies from 10 to 300/100 000. The peak age of onset is between 50 and 60 yr with a male-to-female ratio of 1:2. In this article, we present a review of the pathophysiology, diagnosis, and treatment of TN based on available evidence.

Aetiology and pathophysiology

The exact aetiology and pathophysiology of TN remains to be clearly elucidated. According to the ‘ignition theory’ (the most common hypothesis), TN is the result of abnormalities in the afferent neurones of the trigeminal root or ganglion.1 Any injury to the axons can make them hyperexcitable, leading to this painful neuropathic condition. It has been suggested that central sensitization also plays a role in TN. Some of the risk factors in developing TN are multiple sclerosis (MS), increased age, stroke, hypertension (in women), Charcot–Marie–Tooth disease, and tumours in the region of the trigeminal nerve root.

In the majority of TN cases, the cause is thought to be demyelination of the trigeminal nerve root near its entry into the pons. …

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