Trigeminal Neuralgia

Trigeminal neuralgia is a rare neuropathic pain condition but can be very disabling. The hallmark is brief episodes of intense, radiating pain within the territory of trigeminal nerve distribution. It is typically unilateral, often accompanied by facial spasms and can be triggered by facial movements in a majority of patients. Microvascular compression of trigeminal ganglion is the etiology for most patients with classical trigeminal neuralgia. Some patients can have continuous facial pain in addition to paroxysms of pain. Trigeminal neuralgia is a clinical diagnosis, but MRI is done to rule out secondary causes or to detect microvascular compression. Pharmacological therapy with first-line agents—carbamazepine or oxcarbazepine—is the preferred treatment. Patients with failed pharmacological therapy are considered for surgical decompression, ablation procedures, or Gamma Knife surgery.