Trigeminal Neuralgia (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
In this Article
- Introduction to trigeminal neuralgia (TN)
- What is trigeminal neuralgia (TN)?
- What causes trigeminal neuralgia?
- What are the symptoms of trigeminal neuralgia?
- How is trigeminal neuralgia diagnosed?
- What is the treatment for trigeminal neuralgia?
What are the symptoms of trigeminal neuralgia?
Symptoms of trigeminal neuralgia include an acute onset of sharp, stabbing pain to one side of the face. It tends to begin at the angle of the jaw and radiate along the junction lines; between the ophthalmic branchV1 and maxillary branch V2, or the maxillary branch V2 and the mandibular branch V3.
The pain is severe and described as an electric shock. It may be made worse by light touch, chewing, or cold exposure in the mouth. In the midst of an attack, affected individuals shield their face trying to protect it from being touched. This is an important diagnostic sign because with many other pain syndromes like a toothache, the person will rub or hold the face to ease the pain.
While there may be only one attack of pain, the person may experience recurrent sharp pain every few hours or every few seconds. Between the attacks, the pain resolves completely and the the person has no symptoms. However, because of fear that the intense pain might return, people can be quite distraught. Trigeminal neuralgia tends not to occur when the person is asleep, and this differentiates it from migraines, which often waken the person.
After the first episode of attacks, the pain may subside for months or years but there is always the risk that trigeminal neuralgia will recur without warning.
How is trigeminal neuralgia diagnosed?
Idiopathic trigeminal neuralgia is a clinical diagnosis and often no testing is required after the health care professional takes a history of the situation and performs a physical examination which should be normal.
It is important to remember that the neurologic exam must be normal. There are two specific areas to test. There can be no muscle weakness; V3 is responsible for chewing and there can be no jaw or facial weakness found. The corneal reflex controlled by V1 must be present. When the cornea or covering of the eye is touched, the eye blinks in response. If these two findings are not normal, the search should begin for an inflammatory or compression cause of the trigeminal nerve. Some clinicians may order an MRI to help diagnose other conditions that may cause trigeminal neuralgia.
The International Headache Society has established criteria for making the diagnosis and includes the following:
- Paroxysmal attacks of pain lasting from a fraction of a second to 2 minutes, affecting 1 or more divisions of the trigeminal nerve and fulfilling criteria B and C.
- Pain has at least one of the following characteristics: (1) intense, sharp, superficial or stabbing; or (2) precipitated from trigger areas or by trigger factors
- Attacks stereotyped in the individual patient
- No clinically evident neurologic deficit
- Not attributed to another disorder
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