Trigeminal Neuralgia

BASICS

Trigeminal neuralgia (TN) is a painful disorder of the sensory nucleus of the 5th cranial (trigeminal) nerve that commonly produces episodic, paroxysmal, severe, lancinating facial pain lasting seconds to minutes
Often precipitated by stimulation of well-defined, ipsilateral trigger zones: usually perioral, perinasal, and occasionally intraoral (e.g., by talking, washing your face, shaving, or exposure to cold air)
Subtypes:
- Classical: secondary to neurovascular compression, as evidenced by MRI
- Idiopathic: when the criterion for TN is met, with evidence on MRI or electrophysiologic testing, suggestion no apparent or visible etiology
- Secondary: diagnosed based on fulfillment of criteria for TN but attributed to a separate causative comorbid condition. The three subtypes of secondary TN are attributed to multiple sclerosis (MS), space-occupying lesions (such as cerebellopontine angle tumors, meningioma, etc.), or other causes (1)[A]
System(s) affected: nervous
Synonym(s): tic douloureux; Fothergill neuralgia; trifacial neuralgia; prosopalgia

Pregnancy Considerations
Teratogenicity of medication therapy limits their use during 1st and 2nd trimesters

Compression of the trigeminal nerve root by an anomalous artery, vein, or tumor such as meningioma or acoustic neuroma.
Demyelination from compression, or other cause such as MS, leads to an ectopic impulse generation with erratic responses such as hyperexcitability of damaged nerves and transmission of action potentials along adjacent, undamaged, and unstimulated sensory fibers.

Prevalence of familial TN is about 1–2%.
Autosomal dominant inheritance pattern suggested
Other presentations may be attributed to gene mutations of calcium channels, sodium channels, MPZ gene, etc.

MS associated with a 20-fold increased risk of developing TN

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