Acute Exacerbation of Trigeminal Neuralgia

1. Acute Exacerbation of Trigeminal
Neuralgia
Ade Wijaya, MD – September 2023

2. Outline:
 Introduction
 Classification
 Epidemiology
 Clinical Manifestation
 Management
 Summary

3. Introduction
 Trigeminal neuralgia (TN) is a painful
condition that is associated with sudden,
lancinating, unilateral pain attacks in the
distribution of the trigeminal nerve
branches.
 The attacks last from a few seconds up
to 2 min and are often associated with
typical triggers (e.g. brushing teeth,
talking, eating).
 There is generally no pain between
Olesen J. International classification of headache disorders. The Lancet Neurology. 2018 May 1;17(5):396-7.

4. Classification of TN
Primary
• Compression by blood vessel
Secondary
• Tumor
• Demyelination (multiple
sclerosis)
Cruccu G, Finnerup NB, Jensen TS, Scholz J, Sindou M, Svensson P, Treede RD, Zakrzewska JM, Nurmikko T. Trigeminal neuralgia: new classification and
diagnostic grading for practice and research. Neurology. 2016 Jul 12;87(2):220-8.

5. Epidemiology
 The annual incidence of TN is
reported as 4.7–28.9 per 100 000
person years
 The age of onset is 53–60 yr
 1.5–1.9 times more common in
women
Moore D, Chong MS, Shetty A, Zakrzewska JM. A systematic review of rescue analgesic strategies in acute exacerbations of primary trigeminal neuralgia.
British journal of anaesthesia. 2019 Aug 1;123(2):e385-96.

6. Clinical Manifestation
 Moderate to severe episodes of pain with
associated functional, occupational, and
emotional impairment and disability
 Most treatment options in TN are
symptomatic and aim to reduce the
severity and frequency of attacks in the
future
 There is limited evidence on
interventions that offer rescue analgesia
in the acute phase of an exacerbation or
attack
Zakrzewska JM, Wu J, Mon-Williams M, Phillips N, Pavitt SH. Evaluating the impact of trigeminal neuralgia. Pain. 2017 Jun 1;158(6):1166-74.

7. Acute Exacerbation
Management
Moore D, Chong MS, Shetty A, Zakrzewska JM. A systematic review of rescue analgesic strategies in acute exacerbations of primary trigeminal neuralgia.
British journal of anaesthesia. 2019 Aug 1;123(2):e385-96.
Most of the interventions give
less than 24 h of pain relief,
so a more definitive care plan
needs to be put in place

8. Summary
 Trigeminal neuralgia is associated with
periods of moderate to severe flare-up
that can have a detrimental impact on an
individual's personal and professional life
 Many current treatment strategies are
aimed at long-term symptom control and
fail to give acute pain control (within 24
h)
 Weak evidence exists to support the use
of lidocaine, sumatriptan,
phenytoin/fosphenytoin, botulinum toxin,
and MgSO4 as acute rescue analgesics
 Future studies needed

9. THANK YOU