Trigeminal Neuralgia


formerly tic douloureux



  • 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


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

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