The trigeminal nerve and its three major divisions (shown in yellow): the ophthalmic nerve (V1), the maxillary nerve (V2), and the mandibular nerve (V3)
Specialty
Neurology
Symptoms
Typical: episodes of severe, sudden, shock-like pain in one side of the face that lasts for seconds to minutes[1] Atypical: constant burning pain[1]
Complications
Depression[5]
Usual onset
> 50 years old[1]
Types
Typical and atypical trigeminal neuralgia[1]
Causes
Believed to be due to problems with myelin of trigeminal nerve[1][6]
Diagnostic method
Based on symptoms[1]
Differential diagnosis
Postherpetic neuralgia[1]
Treatment
Medication, surgery[1]
Medication
Carbamazepine, oxcarbazepine[6]
Prognosis
80% improve with initial treatment[6]
Frequency
1 in 8,000 people per year[1]
Trigeminal neuralgia (TN or TGN), also called Fothergill disease, tic douloureux, trifacial neuralgia, or suicide disease, is a long-term pain disorder that affects the trigeminal nerve,[7][1] the nerve responsible for sensation in the face and motor functions such as biting and chewing. It is a form of neuropathic pain.[8] There are two main types: typical and atypical trigeminal neuralgia.[1] The typical form results in episodes of severe, sudden, shock-like pain in one side of the face that lasts for seconds to a few minutes.[1] Groups of these episodes can occur over a few hours.[1] The atypical form results in a constant burning pain that is less severe.[1] Episodes may be triggered by any touch to the face.[1] Both forms may occur in the same person.[1] It is regarded as one of the most painful disorders known to medicine, and often results in depression and suicide.[5]
The exact cause is unknown, but believed to involve loss of the myelin of the trigeminal nerve.[1][6] This might occur due to compression from a blood vessel as the nerve exits the brain stem, multiple sclerosis, stroke, or trauma.[1] Less common causes include a tumor or arteriovenous malformation.[1] It is a type of nerve pain.[1] Diagnosis is typically based on the symptoms, after ruling out other possible causes such as postherpetic neuralgia.[8][1]
Treatment includes medication or surgery.[1] The anticonvulsant carbamazepine or oxcarbazepine is usually the initial treatment, and is effective in about 90% of people.[8] Side effects are frequently experienced that necessitate drug withdrawal in as many as 23% of patients.[8] Other options include lamotrigine, baclofen, gabapentin, amitriptyline and pimozide.[6][1] Opioids are not usually effective in the typical form.[1] In those who do not improve or become resistant to other measures, a number of types of surgery may be tried.[6]
It is estimated that trigeminal neuralgia affects around 0.03% to 0.3% of people around the world with a female over-representation around a 3:1 ratio between women and men.[9] It usually begins in people over 50 years old, but can occur at any age.[1] The condition was first described in detail in 1773 by John Fothergill.[10]
^ abcdefghijklmnopqrstuvwxyz"Trigeminal Neuralgia Fact Sheet". NINDS. National Institutes of Health. 17 March 2020. Retrieved 5 April 2021.
^Hackley CE (1869). A text-book of practical medicine. D. Appleton & Co. p. 292. Retrieved 2011-08-01. prosopalgia.
^Bagheri SC, Farhidvash F, Perciaccante VJ (December 2004). "Diagnosis and treatment of patients with trigeminal neuralgia". Journal of the American Dental Association. 135 (12): 1713–1717. doi:10.14219/jada.archive.2004.0124. PMID 15646605. Archived from the original on July 11, 2012. Retrieved 2011-08-01.
^Adams H, Pendleton C, Latimer K, Cohen-Gadol AA, Carson BS, Quinones-Hinojosa A (May 2011). "Harvey Cushing's case series of trigeminal neuralgia at the Johns Hopkins Hospital: a surgeon's quest to advance the treatment of the 'suicide disease'". Acta Neurochirurgica. 153 (5): 1043–1050. doi:10.1007/s00701-011-0975-8. PMID 21409517. S2CID 28245294.
^ abOkeson JP (2005). "6". In Lindsay Harmon (ed.). Bell's orofacial pains: the clinical management of orofacial pain. Quintessence Publishing Co, Inc. p. 114. ISBN 0-86715-439-X. Archived from the original on 2014-01-12.
^ abcdefObermann M (March 2010). "Treatment options in trigeminal neuralgia". Therapeutic Advances in Neurological Disorders. 3 (2): 107–115. doi:10.1177/1756285609359317. PMC 3002644. PMID 21179603.
^"Trigeminal Neuralgia". National Organization for Rare Disorders, Inc. 26 February 2014.
^ abcdCruccu G, Di Stefano G, Truini A (August 2020). Ropper AH (ed.). "Trigeminal Neuralgia". The New England Journal of Medicine. 383 (8): 754–762. doi:10.1056/NEJMra1914484. PMID 32813951. S2CID 221201036.
^Araya EI, Claudino RF, Piovesan EJ, Chichorro JG (2020-01-23). "Trigeminal Neuralgia: Basic and Clinical Aspects". Current Neuropharmacology. 18 (2): 109–119. doi:10.2174/1570159X17666191010094350. PMC 7324879. PMID 31608834.
^Prasad S, Galetta S (March 2009). "Trigeminal neuralgia: historical notes and current concepts". The Neurologist. 15 (2): 87–94. doi:10.1097/nrl.0b013e3181775ac3. PMID 19276786. S2CID 23500191.
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