Trigeminal neuralgia is characterized by intense, unilateral facial pain and is primarily idiopathic, but can also result from vascular compression or tumors. Diagnosis is clinical, with consideration for secondary causes through MRI if indicated. Treatment options include carbamazepine, oxcarbazepine, and various surgical interventions if medical management fails.

1. Trigeminal Neuralgia
Abdullatif Sami Al Rashed
ENT Block 5.6
College of Medicine, KFU
Al-Ahsa, Saudi Arabia

2. Anatomy of Trigeminal Nerve

3. Introduction
 Idiopathic trigeminal neuralgia is marked by
paroxysms of intense, stabbing pain on one
side of the face (tic douloureux).

4. Clinical Features
 recurrent episodes of sudden onset, excruciating
unilateral paroxysmal shooting “electric” pain in
trigeminal root territory (V3>V2>>V1)
 may have normal sensory exam
 pain lasts seconds/minutes over days/weeks; may
remit for weeks/months
 triggers:
 touching face, eating, talking, cold wind, shaving,
applying make-up

5. Etiology
 classic TN: idiopathic
 secondary TN: compression by tortuous blood
vessel (superior cerebellar artery),
cerebellopontine angle tumor (5%), MS (5%)

6. Epidemiology
 F>M; usually middle-aged and elderly

7. Diagnosis
 clinical diagnosis
 investigate for secondary causes, which are
more likely if bilateral TN or associated
sensory loss:
 MRI to rule out structural lesion, MS, or
vascular lesion

8. Treatment
 first line: carbamazepine or oxcarbazepine
 second line: baclofen or lamotrigine
 narcotics not generally recommended
 if medical treatment fails:
 Gasserian ganglion percutaneous technique,
 gamma knife,
 invasive percutaneous denervation
(radiofrequency/glycerol),
 percutaneous balloon microcompression,
 microvascular decompression

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