Trigeminal Neuralgia
Also
known as tic douloureux, trigeminal neuralgia is an idiopathic pain syndrome
resulting in sudden, severe, sharp pain starting near the side of the mouth and
progressing to the ear, eye, or
nostril. Attacks can be triggered by touch or movement such as talking or by
eating. Trigeminal neuralgia can be
so severe as to be nearly incapacitating. The pain lasts for a few seconds and disappears. Despite
the pain, the sensory examination will be normal.
Generally, trigeminal neuralgia is felt to be secondary to compression
of the trigeminal nerve root by a blood vessel. Occasionally it can be a
manifestation of multiple sclerosis or a posterior fossa tumor. With the exception of multiple
sclerosis or the posterior fossa tumor, all
imaging and neurologic testing will be normal.
Carbamazepine is the standard of care for treatment. In those not controlled with carbam-
azepine, phenytoin, baclofen, or gabapentin can be tried.
In those not responding to any form of
medical therapy, surgery
or radio-frequency lesioning into the affected nerve may work.
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