Trigeminal Neuralgia

Presentation

• Sudden, severe, electricity-like shooting facial pain - Lasts few seconds in trigeminal nerve distribution (jaw, teeth or gums)

• Tic Douloureux - Pain causes patient to screw up their face

Triggers - Washing face, Shaving, Eating, Talking, Brushing teeth

Causes - Vascular compression, MS

Investigations

• Exclude differentials – Migraine, GCA, MSK pain

• MRI – Not neccesary, and mainl used if wanting to find possible cause and rule out other secondary causes

Management

Conservative - Avoid triggers

Medical:

• Carbamazepine (1st line) – Anticonvulsant that helps slows down nerve impulses to relieve pain

  • Started on 100mg TDS, and then titrated up by 100-200mg every 2 wks until pain is relieved

• 2nd line options – Oxcarbazepine, Lamotrigine, Baclofen (antispasmodic)

Surgical - Microvascular decompression in order to relieve the pressure on the nerve