Synonyms:
formerly tic douloureux
Diagnosis:
Clinical:
- Brief electric shock like pains or stabbing
- +last 1 second to 2 minutes
- +in the distribution of the trigeminal nerve
- +attacks are stereotyped
- May be triggered by light touch of areas supplied by the trigeminal nerve
- Primary (classic) or secondary forms
Electrophysiology: trigeminal nerve reflexes can distinguish between primary & secondary causes
Investigations to consider:
If young investigations for MS
If not young MRI for posterior fossa tumour
Consider electrophysiology for trigeminal nerve reflexes
Neuralgias due to Trigeminal nerve branches:
Superior laryngeal neuralgia
Nasociliary neuralgia, formerly Charlin’s neuralgia
Supraorbital neuralgia
Infraorbital, lingual, alveolar and mental nerves.
Occipital neuralgia
Treatment:
First line:
- Carbamazepine CBZ 200-1200mg
- Oxcarbazepine OXC 600-1800mg/day
Second line:
- Lamotrigine LTG, Baclofen, Pimozide (no longer used)
If refractory, Consider surgery:
- Dorsal root entry zone lesion DREZ
- Posterior fossa microvascular decompression