Introduction
Trigeminal neuralgia is a pain syndrome characterised by severe unilateral pain. The vast majority of cases are idiopathic but compression of the trigeminal roots by tumours or vascular problems may occur.
Epidemiology
- Incidence: 15.00 cases per 100,000 person-years
- Peak incidence: 60-70 years
- Sex ratio: more common in females 2:1
| Condition | Relative incidence |
|---|---|
| Trigeminal neuralgia | 1 |
| Cluster headache | 0.67 |
| Paroxysmal hemicrania | 0.01 |
| <1 | 1-5 | 6+ | 16+ | 30+ | 40+ | 50+ | 60+ | 70+ | 80+ |
Clinical features
The International Headache Society defines trigeminal neuralgia as:
NICE Clinical Knowledge Summaries list the following as red flag symptoms and signs suggesting a serious underlying cause:
- a unilateral disorder characterised by brief electric shock-like pains, abrupt in onset and termination, limited to one or more divisions of the trigeminal nerve
- the pain is commonly evoked by light touch, including washing, shaving, smoking, talking, and brushing the teeth (trigger factors), and frequently occurs spontaneously
- small areas in the nasolabial fold or chin may be particularly susceptible to the precipitation of pain (trigger areas)
- the pains usually remit for variable periods
NICE Clinical Knowledge Summaries list the following as red flag symptoms and signs suggesting a serious underlying cause:
- Sensory changes
- Deafness or other ear problems
- History of skin or oral lesions that could spread perineurally
- Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally
- Optic neuritis
- A family history of multiple sclerosis
- Age of onset before 40 years
Management
Management
- carbamazepine is first-line
- failure to respond to treatment or atypical features (e.g. < 50 years old) should prompt referral to neurology