A Comprehensive Review of Trigeminal Neuralgia

• Published in: Current pain and headache reports Vol. 23; no. 10; pp. 74 - 7
• Main Authors: Jones, Mark R., Urits, Ivan, Ehrhardt, Ken P., Cefalu, John N., Kendrick, Julia B., Park, Daniel J., Cornett, Elyse M., Kaye, Alan D., Viswanath, Omar
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2019; Springer Nature B.V
• Subjects: Age; Anesthesiology; Decompression - methods; Facial Pain - etiology; Facial Pain - therapy; Headaches; Humans; Internal Medicine; Medicine; Medicine & Public Health; Multiple sclerosis; Neuralgia - diagnosis; Neuralgia - therapy; Other Pain (A Kaye and N Vadivelu; Pain; Pain Medicine; Patients; Section Editors; Topical Collection on Other Pain; Treatment Outcome; Trigeminal Nerve - pathology; Trigeminal Nerve - surgery; Trigeminal Neuralgia - diagnosis; Trigeminal Neuralgia - therapy; Microvascular decompression; Trigeminal neuralgia; Facial pain; Anti-convulsant; Neuromodulation; Chronic pain; Neuropathic pain
• ISSN: 1531-3433; 1534-3081; 1534-3081
• DOI: 10.1007/s11916-019-0810-0

Purpose of Review Trigeminal neuralgia (TN) is characterized by recurrent attacks of lancinating facial pain in the dermatomal distribution of the trigeminal nerve. TN is rare, affecting 4 to 13 people per 100,000. Recent Findings Although there remains a debate surrounding the pathogenesis of TN, neurovascular compromise is the most currently accepted theory. Minimal stimulation caused by light touch, talking, or chewing can lead to debilitating pain and incapacitation of the patient. Pain may occur sporadically, though is primarily unilateral in onset. The diagnosis is typically determined clinically. Treatment options include medications, surgery, and complementary approaches. Summary Anti-epileptic and tricyclic antidepressant medications are first-line treatments. Surgical management of patients with TN may be indicated in those who have either failed medical treatment with at least three medications, suffer from intolerable side-effects, or have non-remitting symptoms. Surgical treatment is categorized as either destructive or non-destructive. Deep brain and motor cortex neuro-modulatory stimulation are off label emerging techniques which may offer relief to TN that is otherwise refractory to pharmacological management and surgery. Still, sufficient data has yet to be obtained and more studies are needed.