trigeminal neuralgia

introduction

patients with trigeminal neuralgia have pain in the trigeminal nerve distribution presumably as a result of some irritation to the trigeminal nerve
- 97% have unilateral pain
it mainly occurs in those aged > 50yrs (may occur at any age though), women twice as common as men
those who develop it at a younger age without traumatic cause should be considered for IX an underlying cause such as:
- multiple sclerosis (MS)
- post. fossa tumour such as an acoustic neuroma, meningioma, etc
- rarely, tuberculosis (TB), sarcoidosis, etc
patients may have either or both forms:
- “typical” type 1 form“:
  - extreme, sporadic, sudden burning or shock-like facial pain that lasts anywhere from a few seconds to as long as two minutes per episode
  - episodes usually precipitated by light touch, shaving, brushing teeth, washing, cold winds, vibrations, etc
- “atypical” type 2 form”:
  - lower intensity, constant aching, burning, or stabbing pain
carbamazepine has the most evidence for efficacy and should be used as first-line Rx