Trigeminal Neuralgia

Trigeminal Neuralgia has been described as one of the most severe pain syndromes. It is characterized by excruciating, electric shock like, shooting/stabbing pain in the distribution of Trigeminal nerve in the face. It is unilateral during any one episode, abrupt onset with pain-free intervals between attacks. Pain is triggered by some non-noxious stimuli like touching of face, chewing, swallowing or even talking. Tumors, vascular malformations, dental disease, sinusitis may cause trigeminal neuralgia, but the etiology in the majority of the cases is unknown.

The condition occurs more often in the middle aged and is twice as common in females as in males. In most of the patients the pain is strictly unilateral; multiple sclerosis patients constitute the majority of the 2% patients with bilateral disease. Trigeminal neuralgia is twice as common on the right side. Most commonly patients present with pain maximum either in maxillary or mandibular divisions.

Investigations: A small group of patients have trigeminal neuralgia due to identifiable brain lesions. MR angiogram might show relationship between blood vessel and fifth cranial nerve. Sometimes it can pick up masses or multiple sclerosis pictures. Most of the patients in the initial stages respond very well to pharmacological therapy. As the duration of disease extends, the medications become ineffective and patient will require an interventional procedure.