Trigeminal neuralgia is a condition in which the patient experiences sudden, lightning-like paroxysms of pain in the distribution of one or more divisions of the trigeminal nerve.
The eetiology of trigeminal neuralgia is obscure and could be due to diabetes, Herpes zoster or alcohol.
When the onset of this disease occurs after 50 years it usually reflects a vascular compression by a tortuous artery at the base of the brain.
If the onset occurs in younger individuals it often results from a Gasserian ganglion tumor or multiple sclerosis.
The history is diagnostic. The pain occurs as brief, lightning-like attacks, frequently precipitated by touching a trigger zone around the lips or the buccal cavity. At times, talking, eating, or brushing the teeth serves as a trigger. The pains rarely last longer than seconds, and each burst is followed by a refractory period of several seconds to a minute during which no pain can be precipitated. The pain is limited to the distribution of the trigeminal nerve, usually involving the second or third division or both.
The pain rarely occurs at night. Ordinarily, the neurologic examination is entirely normal. Sensory changes in the distribution of the trigeminal nerve should prompt a careful/ search for structural disease such as tumor.
Carbamazepine is the initial treatment of choice; phenytoin and baclofen are occasionally effective.
If medical treatment fails, either radiofrequency lesions of the Gasserian ganglion (to block sensory conduction) or surgical relief of vascular pressure on the nerve is indicated.