5th August 2024

Trigeminal neuralgia

Trigeminal neuralgia describes neuropathic facial pain along at least one division of the trigeminal nerve. The pain usually lasts a few seconds and the attacks can be triggered by stimuli such as touch and the cold. The majority of cases are caused by compression of the nerve root, however it is also seen in multiple sclerosis, head injury, cerebellopontine angle tumour, arteriovenous malformations or herpes zoster infection. The presence of sensory loss, bilateral symptoms, optic neuritis or presentation under the age of 40 are concerning for a secondary cause of trigeminal neuralgia such as multiple sclerosis. These cases would need further investigation with MRI.

The first line treatment is with carbamazepine which is started at a dose of 100-200 mg twice a day and gradually uptitrated. If medical treatment fails, then surgical options such as microvascular decompression or ablative procedures can be considered.