Trigeminal neuralgia (TN or TGN) is a chronic pain disorder that affects the trigeminal nerve. There are two main types: typical and atypical trigeminal neuralgia. The typical form results in episodes of severe, sudden, shock like pain in one side of the face that lasts for seconds to a few minutes. Groups of these episodes can occur over a few hours. The atypical form results in a constant burning pain that is less severe. Episodes may be triggered by any touch to the face. Both forms may occur in the same person. It is one of the most painful conditions and can result in depression.
The exact cause is unclear but believed to involve loss of the myelin around the trigeminal nerve. This may occur due to compression from a blood vessel as the nerve exits the brain stem, multiple sclerosis, stroke, or trauma. Less common causes include a tumor or arteriovenous malformation. It is a type of nerve pain. Diagnosis is typically based on the symptoms after ruling out other possible causes such as postherpetic neuralgia.
Treatment includes medication or surgery. The anticonvulsant carbamazepine or oxcarbazepine is the usual initial treatment and is effective in about 80% of people. Other options include lamotrigine, baclofen, gabapentin, and pimozide. Amitriptylinemay help with the pain but opioids are not usually effective in the typical form. In those who do not improve or become resistant to other measures, a number of types of surgery may be tried.
It is estimated that 1 in 8,000 people develop trigeminal neuralgia a year. It usually begins in people over 50 years old, but can occur at any age. Women are more commonly affected than men. The condition was first described in detail in 1773 by John Fothergill.
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https://www.hindawi.com/journals/crid/2016/4605231/ yuko ono, tsuyoshi shimo, yoshinori shirafuji, et al., “drug-induced hypersensitivity syndrome caused by carbamazepine used for the treatment of trigeminal neuralgia,” case reports in dentistry, vol. 2016, article id 4605231, 4 pages, 2016. doi:10.1155/2016/4605231
https://www.hindawi.com/journals/crim/2011/258910/ guy c. jones, ameer l. elaimy, john j. demakas, et al., “feasibility of multiple repeat gamma knife radiosurgeries for trigeminal neuralgia: a case report and review of the literature,” case reports in medicine, vol. 2011, article id 258910, 4 pages, 2011. doi:10.1155/2011/258910
https://www.hindawi.com/journals/crim/2013/398513/ alexander mason, kristen ayres, sigita burneikiene, alan t. villavicencio, e. lee nelson, and sharad rajpal, “a novel case of resolved postherpetic neuralgia with subsequent development of trigeminal neuralgia: a case report and review of the literature,” case reports in medicine, vol. 2013, article id 398513, 3 pages, 2013. doi:10.1155/2013/398513
de almeida holanda mm, pereira neto ng, de moura peixoto g, pinheiro santos rh. trigeminal neuralgia secondary to basilar impression: a case report. j craniovert jun spine [serial online] 2015 [cited 2017 jan 26];6:76-8. available from: http://www.jcvjs.com/text.asp?2015/6/2/76/156062