Trigeminal Neuralgia | Prosopalgia | Attacks of Lancinating Pain | Paroxysms

What is Trigeminal Neuralgia?

• Trigeminal Neuralgia is a disorder characterized by paroxysmal, brief attacks of lancinating pain in the distribution of one or more divisions of the trigeminal nerve.
• Mean age of onset is 5^th to 6^th decade and usually no cause is found (The idiopathic form).
• Occasionally it may begin at 30-35yrs of age due to a recognizable cause (the symptomatic form).

Symptoms of Trigeminal Neuralgia (Prosopalgia)

• Pain usually occurs in 2^nd or 3^rd division of the nerve.
• Pain is episodic and brief and has a shock like character.
• Paroxysm may followed by a dull ‘after pain’ which may spread to the remaining half of the face.
• Attacks may be precipitated by cold water, washing the face, shaving, talking, and mastication or swallowing.
• There are trigger points over face, teeth and the mouth mucosa; stimulation of these initiates the attack.
• Usually no sensory or motor deficit is detected.
• The neuralgia may be a presenting feature of pontine neoplasm, multiple sclerosis, granulomas and inflammation around the Gasserian ganglion.

Idiopathic and Symptomatic Form of Trigeminal Neuralgia

• It is important to differentiate between idiopathic and symptomatic forms of Trigeminal Neuralgia.
• Presence of sensory loss and a younger age onset favors symptomatic Trigeminal Neuralgia.
• Secondly, impaired electro-physiological measurement of the blind reflex and newer imaging techniques like CT-scan and MRI help to identify the symptomatic form of Trigeminal Neuralgia.
• The characteristic pain of Trigeminal Neuralgia usually makes it possible to differentiate it from other varieties of facial pain.

Diagnosis of Prosopalgia (Paroxysms)

• Post herpetic trigeminal pain is usually distinguished by history of zoster and residual scars.
• Referred pain to trigeminal distribution by frontal and maxillary sinusitis, glaucoma and dental caries can be differentiated by presence of associated clinical signs.
• Migraine like neuralgia or cluster headache can cause pain in trigeminal distribution but it is throbbing variety.

Treatment of Trigeminal Neuralgia

• Most effective drug in Trigeminal Neuralgia is carbamazepine.
• Dose of carbamazepine is increased slowly until total relief is obtained and continued for few weeks to months.
• Other drugs which are effective are phenytoin, baclofen and amitriptyline.

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