Trigeminal Neuralgia

Trigeminal Neuralgia is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • A painful disorder of the sensory nucleus of the trigeminal nerve (cranial nerve [CN] V) that produces episodic, paroxysmal, severe, lancinating facial pain lasting seconds to minutes in the distribution of ≥1 divisions of the nerve
  • Often precipitated by stimulation of well-defined, ipsilateral trigger zones: usually perioral, perinasal, and occasionally intraoral (e.g., by washing, shaving)
  • System(s) affected: nervous
  • Synonym(s): tic douloureux; Fothergill neuralgia; trifacial neuralgia; prosopalgia

Epidemiology

Incidence
  • Women: 5.9/100,000 per year
  • Men: 3.4/100,000 per year
  • >70 years of age: ~25.6/100,000 per year
  • Predominant age:
    • >50 years; incidence increases with age.
    • Rare: <35 years of age (Consider another primary disease; see “Etiology and Pathophysiology.”)
  • Predominant sex: female > male (~2:1)

Prevalence
16/100,000

Pediatric Considerations
Unusual during childhood

Pregnancy Considerations
Teratogenicity limits therapy for 1st and 2nd trimesters.

Etiology and Pathophysiology

  • Demyelination around the compression site seems to be the mechanism by which compression of nerves leads to symptoms.
  • Demyelinated lesions may set up an ectopic impulse generation causing erratic responses: hyperexcitability of damaged nerves and transmission of action potentials along adjacent, undamaged, and unstimulated sensory fibers.
  • Compression of trigeminal nerve by anomalous arteries or veins of posterior fossa, compressing trigeminal root
  • Etiologic classification:
    • Idiopathic (classic)
    • Secondary: cerebellopontine angle tumors (e.g., meningioma); tumors of CN V (e.g., neuroma, vascular malformations), trauma, demyelinating disease (e.g., multiple sclerosis [MS])

Risk Factors

Unknown

Commonly Associated Conditions

  • Sjögren syndrome; rheumatoid arthritis
  • Chronic meningitis
  • Acute polyneuropathy
  • MS
  • Hemifacial spasm
  • Charcot-Marie-Tooth neuropathy
  • Glossopharyngeal neuralgia

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