Background/Epidemiology
- Estimated incidence ~27/100000. Peak incidence between 50-60 (prevalence increases with age); more common in females
- Characterised by unilateral ‘lancinating’ facial pain, usually over the V2/V3 distribution
- Thought to be caused by an irritative lesion of the trigeminal root. This may be an aberrant loop of artery or another benign lesion e.g. MS plaque (TN can be associated with MS)
Presentation
- Repetitive, severe, brief pain which may be triggered by touch, cold temperature or movement e.g. eating.
- Patient may experience wincing spasms
- Usually a relapsing/remitting course of episodic spells of pain
Management
- Pain usually responds to carbamazepine (begin low and titrate to effect)
- Second line agents include gabapentin, pregabalin, amitriptyline or steroids
- Incomplete response to medical treatment may be an indication for surgery
- Decompression of the vascular loop at the trigeminal root can have good success rates
- If symptoms are unbearable and persistent, nerve ablation using alcohol/phenol injection is possible, but will leave the area numb (which can be equally distressing)
Notes on Medicine/Surgery 