Trigeminal neuralgia

Question 1

what is trigeminal neuralgia

Answer 1

electric shock like pain in the distribution of 1 or more of the trigeminal nerve divisions, unilaterally

V1 - opthalmic
V2 - maxillary
V3 - mandibular

Question 2

what are the features of trigeminal neuralgia

Answer 2

unilateral sharp, stabbing, electric shock like pain
occur in the distribution of 1 or more of the trigeminal nerve divisions
abrupt onset + termination
lasts for max 2mins

triggered by inocuous stimuli - shaving, chewing, washing, wind blowing
can have specific trigger zones e.g. nasolabial area

no associated neurological deificit

Question 3

how is trigeminal neuralgia diagnosed

Answer 3

clinical diagnosis

normal neurological exam - might trigger the pain by touching face

patient should be asymptomatic in between episodes of pain

Question 4

what are the red flags for trigeminal neuralgia

Answer 4

can be serious secondary causes for trigeminal neuralgia rather than it being idiopathic or due to trigeminal nerve root compression

sensory changes
deafness
history of skin or oral lesions that can spread perineurally
pain only in opthalmic division of trigeminal nerve
bilateral pain - likely caused by MS
optic neuritis
fmaily history MS
onset <40yrs old

Question 5

what is the management for trigeminal neuralgia

Answer 5

carbamazepine