Brief Overview: Trigeminal neuralgia (TN) is a chronic pain condition affecting the trigeminal nerve, which carries sensation from the face to the brain. It is characterized by sudden, severe, electric shock–like facial pain, usually on one side of the face. Episodes can last seconds to minutes and may be triggered by everyday activities such as chewing, talking, or touching the face.
Prevalence: According to UpToDate, “TN is a rare condition with an overall prevalence of <0.1 percent in the general population.”
Etiology: According to UpToDate, “Compression of the trigeminal nerve root is the main causal mechanism of TN, but brainstem lesions account for a small proportion of cases. Other cases of TN may be idiopathic with no structural cause found despite advanced imaging or surgical exploration. Central sensitization and/or genetic susceptibility may contribute to these cases.”
Risk Factors:
- Female
- HTN
- Migraine
- Age > 50 years
Commonly Associated Conditions:
- HTN
- Migraine
- MS
- Anxiety, depression due to pain
Common Medications:
- Preventive Medications: carbamazepine, oxcarbazepine
- Alternative/Adjunct: gabapentin, lamotrigine, baclofen
- Others: Botox, tizanidine, pregabalin, phenytoin, pimozide
- Acute therapy: intranasal/IV lidocaine, subcutaneous sumatriptan, IV phenytoin or fosphenytoin, IV locosamide
Common Labs, Imaging, and Tests:
- Brain MRI with and without contrast and MRA
- Trigeminal reflex testing may be used
- Dental evaluation
Common Symptoms:
- Attacks of intense, stabbing pain along the distribution of the trigeminal nerve
- Pain is typically unilateral
- Pain described as electric, shock-like, stabbing
- May have continuous dull pain between attacks of intense pain or may have pain-free intervals
- Pain is typically triggered by something. Can be triggered by talking, chewing, brushing teeth, shaving, touching the face, or wind exposure
Common Treatments:
- Medication, as above
- Surgery may be indicated for some – microvascular decompression, rhizotomy, radiosurgery, peripheral neurectomy
Physical Findings:
- Normal neurological exam in most cases
- May note facial asymmetry if patient avoids movement due to pain
- Pain response triggered by light touch during exam (trigger zones)
Potential Complications and Contraindications:
- Complications of TN itself: Malnutrition, weight loss, depression, anxiety, poor quality of life
- Medication side effects: Drowsiness, dizziness, liver toxicity, hyponatremia, rash (Stevens-Johnson risk with carbamazepine in certain ethnic groups)
- Surgical risks: Hearing loss, facial weakness, persistent numbness
General Health and Lifestyle Guidance:
- Identify and avoid triggers when possible (cold air, chewing tough foods).
- Maintain a balanced diet with softer foods if chewing is painful.
- Stress management and relaxation techniques may reduce flares.
- Good oral hygiene is important but may require gentle modifications.
- Encourage staying socially connected and seeking mental health support if pain affects mood.
Suggested Questions to Ask Patients:
- Can you describe the pain—its location, frequency, and severity?
- What activities or triggers bring on the pain?
- How is the pain affecting your daily life (eating, talking, socializing)?
- Have you noticed any changes in vision, hearing, or balance?
- What medications have you tried, and how effective have they been?
- Have you experienced side effects from your medications?
- Have you been evaluated with imaging (e.g., MRI)?
Suggested Talking Points:
- Trigeminal neuralgia can significantly affect your quality of life. With proper treatment, many people find relief.
- There are both medication and surgical options if pain is not controlled.
- Keeping a pain diary may help identify triggers and guide treatment decisions.
- It’s important to let your healthcare provider know if your pain changes or if medications cause unwanted side effects.
- You are not alone—support groups and counseling may help you cope emotionally.
Sources:
This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.