Sudden, lightning-like paroxysms of pain in the distribution of one or
more divisions of the trigeminal nerve.
Aetiology 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 precipi?tated. The pain is limited to the distribution of
the trigeminal nerve, usually involving the second or third division or
The pain rarely occurs at night. Ordinarily, the neurologic examina?tion
is entirely normal. Sensory changes in the distribution of the trigeminal
nerve should prompt a careful/ search for structural disease such as tumor.
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Carbamazepine is the initial treatment of choice; phenytoin and baclofen
are occa?sionally 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.