Advertisement

A Comprehensive Review of Trigeminal Neuralgia

  • Mark R. Jones
  • Ivan UritsEmail author
  • Ken P. Ehrhardt
  • John N. Cefalu
  • Julia B. Kendrick
  • Daniel J. Park
  • Elyse M. Cornett
  • Alan D. Kaye
  • Omar Viswanath
Other Pain (A Kaye and N Vadivelu, Section Editors)
  • 110 Downloads
Part of the following topical collections:
  1. Topical Collection on Other Pain

Abstract

Purpose of Review

Trigeminal neuralgia (TN) is characterized by recurrent attacks of lancinating facial pain in the dermatomal distribution of the trigeminal nerve. TN is rare, affecting 4 to 13 people per 100,000.

Recent Findings

Although there remains a debate surrounding the pathogenesis of TN, neurovascular compromise is the most currently accepted theory. Minimal stimulation caused by light touch, talking, or chewing can lead to debilitating pain and incapacitation of the patient. Pain may occur sporadically, though is primarily unilateral in onset. The diagnosis is typically determined clinically. Treatment options include medications, surgery, and complementary approaches.

Summary

Anti-epileptic and tricyclic antidepressant medications are first-line treatments. Surgical management of patients with TN may be indicated in those who have either failed medical treatment with at least three medications, suffer from intolerable side-effects, or have non-remitting symptoms. Surgical treatment is categorized as either destructive or non-destructive. Deep brain and motor cortex neuro-modulatory stimulation are off label emerging techniques which may offer relief to TN that is otherwise refractory to pharmacological management and surgery. Still, sufficient data has yet to be obtained and more studies are needed.

Keywords

Trigeminal neuralgia Facial pain Chronic pain Neuropathic pain Anti-convulsant Microvascular decompression Neuromodulation 

Notes

Compliance with Ethical Standards

Conflict of Interest

Mark R. Jones, Ivan Urits, Ken P. Ehrhardt, John N. Cefalu, Julia B. Kendrick, Daniel J. Park, Elyse M. Cornett, and Omar Viswanath declare no conflict of interest. Dr. Kaye is a speaker for Depomed, Inc., and Merck, Inc.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    • Montano N, Conforti G, Di Bonaventura R, Meglio M, Fernandez E, Papacci F. Advances in diagnosis and treatment of trigeminal neuralgia. Ther Clin Risk Manag. 2015;11:289–99 A review of advances in management of TN.CrossRefGoogle Scholar
  2. 2.
    Walker HK, Cranial Nerve V. The trigeminal Nerve. Clin. Methods Hist. Phys. Lab. Exam: Butterworths; 1990.Google Scholar
  3. 3.
    Krafft RM. Trigeminal neuralgia. Am Fam Physician. 2008;77:1291–6.PubMedGoogle Scholar
  4. 4.
    McMillan R. Trigeminal Neuralgia - a debilitating facial pain. Rev pain SAGE Publications;. 2011;5:26–34.CrossRefGoogle Scholar
  5. 5.
    •• Cruccu G, Finnerup NB, Jensen TS, Scholz J, Sindou M, Svensson P, et al. Trigeminal neuralgia: new classification and diagnostic grading for practice and research. Neurology. 2016;87:220–8 Describing a new classification system for TN.CrossRefGoogle Scholar
  6. 6.
    Pearce JMS. Trigeminal neuralgia (Fothergill’s disease) in the 17th and 18th centuries. J Neurol Neurosurg Psychiatry BMJ Publishing Group Ltd;. 2003;74:1688.CrossRefGoogle Scholar
  7. 7.
    Rose FC. Trigeminal Neuralgia. Arch Neurol American Medical Association;. 1999;56:1163.CrossRefGoogle Scholar
  8. 8.
    Katusic S, Beard CM, Bergstralh E, Kurland LT. Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945-1984. Ann Neurol. 1990;27:89–95.CrossRefGoogle Scholar
  9. 9.
    Childs AM, Meaney JF, Ferrie CD, Holland PC. Neurovascular compression of the trigeminal and glossopharyngeal nerve: three case reports. Arch Dis Child. 2000;82:311–5.CrossRefGoogle Scholar
  10. 10.
    Fleetwood IG, Innes AM, Hansen SR, Steinberg GK. Familial trigeminal neuralgia. Case report and review of the literature. J Neurosurg. 2001;95:513–7.CrossRefGoogle Scholar
  11. 11.
    Feller L, Khammissa RAG, Fourie J, Bouckaert M, Lemmer J. Postherpetic Neuralgia and trigeminal Neuralgia. Pain Res Treat Hindawi Limited;. 2017;2017:1681765.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Moisset X, Villain N, Ducreux D, Serrie A, Cunin G, Valade D, et al. Functional brain imaging of trigeminal neuralgia. Eur J Pain European Federation of International Association for the study of pain chapters;. 2011;15:124–31.CrossRefGoogle Scholar
  13. 13.
    Zakrzewska JM, Linskey ME. Trigeminal neuralgia. BMJ. 2015;350:h1238.CrossRefGoogle Scholar
  14. 14.
    Maarbjerg S, Gozalov A, Olesen J, Bendtsen L. Trigeminal neuralgia--a prospective systematic study of clinical characteristics in 158 patients. Headache. 2014;54:1574–82.CrossRefGoogle Scholar
  15. 15.
    Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia. 2018;38:1–211.Google Scholar
  16. 16.
    Eller M, Goadsby P. Trigeminal autonomic cephalalgias. Oral Dis. 2016;22:1–8.CrossRefGoogle Scholar
  17. 17.
    Bope ET, Kellerman RD, Conn HF (Howard F. Conn’s current therapy 2016.Google Scholar
  18. 18.
    Gronseth G, Cruccu G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology. 2008;71:1183–90.CrossRefGoogle Scholar
  19. 19.
    Bennetto L, Patel NK, Fuller G. Trigeminal neuralgia and its management. BMJ. BMJ Publishing Group;. 2007;334:201–5.CrossRefGoogle Scholar
  20. 20.
    Zakrzewska JM, Linskey ME. Trigeminal neuralgia. BMJ. 2014;348:g474–4.CrossRefGoogle Scholar
  21. 21.
    Wu C-J, Lian Y-J, Zheng Y-K, Zhang H-F, Chen Y, Xie N-C, et al. Botulinum toxin type a for the treatment of trigeminal neuralgia: results from a randomized, double-blind, placebo-controlled trial. Cephalalgia. 2012;32:443–50.CrossRefGoogle Scholar
  22. 22.
    McQuay H, Carroll D, Jadad AR, Wiffen P, Moore A. Anticonvulsant drugs for management of pain: a systematic review. BMJ. BMJ Publishing Group;. 1995;311:1047–52.CrossRefGoogle Scholar
  23. 23.
    Al-Quliti KW. Update on neuropathic pain treatment for trigeminal neuralgia. The pharmacological and surgical options. Neurosciences (Riyadh). Medical Services Division, Ministry of Defence;. 2015;20:107–14.CrossRefGoogle Scholar
  24. 24.
    Maarbjerg S, Di Stefano G, Bendtsen L, Cruccu G. Trigeminal neuralgia – diagnosis and treatment. Cephalalgia. 2017;37:648–57.CrossRefGoogle Scholar
  25. 25.
    Lunardi G, Leandri M, Albano C, Cultrera S, Fracassi M, Rubino V, et al. Clinical effectiveness of lamotrigine and plasma levels in essential and symptomatic trigeminal neuralgia. Neurology. 1997;48:1714–7.CrossRefGoogle Scholar
  26. 26.
    Zakrzewska JM, Chaudhry Z, Nurmikko TJ, Patton DW, Mullens EL. Lamotrigine (lamictal) in refractory trigeminal neuralgia: results from a double-blind placebo controlled crossover trial. Pain. 1997;73:223–30.CrossRefGoogle Scholar
  27. 27.
    Wiffen PJ, Rees J. Lamotrigine for acute and chronic pain. In: Wiffen PJ, editor. Cochrane Database Syst Rev. Chichester: John Wiley & Sons, Ltd; 2007. p. CD006044.Google Scholar
  28. 28.
    Zhang J, Yang M, Zhou M, He L, Chen N, Zakrzewska JM. Non-antiepileptic drugs for trigeminal neuralgia. Cochrane Database Syst Rev. 2013:CD004029.Google Scholar
  29. 29.
    Joffroy A, Levivier M, Massager N. Trigeminal neuralgia. Pathophysiology and treatment. Acta Neurol Belg. 2001;101:20–5.PubMedGoogle Scholar
  30. 30.
    Hodaie M, Coello AF. Advances in the management of trigeminal neuralgia. J Neurosurg Sci. 2013:13–21.Google Scholar
  31. 31.
    Ko AL, Ozpinar A, Lee A, Raslan AM, McCartney S, Burchiel KJ. Long-term efficacy and safety of internal neurolysis for trigeminal neuralgia without neurovascular compression. J Neurosurg. 2015;122:1048–57.CrossRefGoogle Scholar
  32. 32.
    Tronnier VM, Rasche D, Hamer J, Kienle AL, Kunze S. Treatment of idiopathic trigeminal neuralgia: comparison of long-term outcome after radiofrequency rhizotomy and microvascular decompression. Neurosurgery. 2001;48:1261–8.PubMedGoogle Scholar
  33. 33.
    Tatli M, Satici O, Kanpolat Y, Sindou M. Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes. Acta Neurochir. 2008;150:243–55.CrossRefGoogle Scholar
  34. 34.
    Koopman JSHA, de Vries LM, Dieleman JP, Huygen FJ, Stricker BHC, Sturkenboom MCJM. A nationwide study of three invasive treatments for trigeminal neuralgia. Pain. 2011;152:507–13.CrossRefGoogle Scholar
  35. 35.
    Simpson DM (David M, McArthur JC, Dworkin RH. Neuropathic pain: mechanisms, diagnosis, and treatment. Oxford University Press; 2012.Google Scholar
  36. 36.
    Baabor MG, Perez-Limonte L. Percutaneous balloon compression of the Gasserian ganglion for the treatment of trigeminal neuralgia: personal experience of 206 patients. Acta Neurochir Suppl. 2011;108:251–4.CrossRefGoogle Scholar
  37. 37.
    Kondziolka D, Lunsford LD. Percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia: technique and expectations. Neurosurg Focus. 2005;18:E7.CrossRefGoogle Scholar
  38. 38.
    North RB, Kidd DH, Piantadosi S, Carson BS. Percutaneous retrogasserian glycerol rhizotomy. J Neurosurg. 1990;72:851–6.CrossRefGoogle Scholar
  39. 39.
    Slettebø H, Hirschberg H, Lindegaard KF. Long-term results after percutaneous retrogasserian glycerol rhizotomy in patients with trigeminal neuralgia. Acta Neurochir. 1993;122:231–5.CrossRefGoogle Scholar
  40. 40.
    Karol A. Technological advances in the surgical management of trigeminal neuralgia. Crit Rev Neurosurg. 1999;9:70–8.CrossRefGoogle Scholar
  41. 41.
    Karol EA, Sanz OP, La Riva FNG, Rey RD. A micrometric multiple electrode array for the exploration of gasserian and retrogasserian trigeminal fibers: preliminary report. Technical note. Neurosurgery. 1993;33:154–8.PubMedGoogle Scholar
  42. 42.
    Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol. 2008;15:1013–28.CrossRefGoogle Scholar
  43. 43.
    Sheehan J, Pan H-C, Stroila M, Steiner L. Gamma knife surgery for trigeminal neuralgia: outcomes and prognostic factors. J Neurosurg. 2005;102:434–41.CrossRefGoogle Scholar
  44. 44.
    Buchanan RJ, Darrow D, Monsivais D, Nadasdy Z, Gjini K. Motor cortex stimulation for neuropathic pain syndromes. Neuroreport. 2014;25:721–3.CrossRefGoogle Scholar
  45. 45.
    Fontaine D, Hamani C, Lozano A. Efficacy and safety of motor cortex stimulation for chronic neuropathic pain: critical review of the literature. J Neurosurg. 2009;110:251–6.CrossRefGoogle Scholar
  46. 46.
    Levy R, Deer TR, Henderson J. Intracranial neurostimulation for pain control: a review. Pain Physician. 13:157–65.Google Scholar
  47. 47.
    Franzini A, Messina G, Cordella R, Marras C, Broggi G. Deep brain stimulation of the posteromedial hypothalamus: indications, long-term results, and neurophysiological considerations. Neurosurg Focus. 2010;29:E13.CrossRefGoogle Scholar
  48. 48.
    Reverberi C, Dario A, Barolat G, Zuccon G. Using peripheral nerve stimulation (PNS) to treat neuropathic pain: a clinical series. Neuromodulation Technol Neural Interface. 2014;17:777–83.CrossRefGoogle Scholar
  49. 49.
    Saver SP, Deogaonkar M, Slavin KV. Neurosurgery clinics of North America peripheral nerve/field stimulation for neuropathic pain. Neurosurg Clin N Am. 2014;25:1–34.CrossRefGoogle Scholar
  50. 50.
    Petersen EA, Slavin KV. Peripheral nerve/field stimulation for chronic pain. Neurosurg Clin N Am. 2014;25:789–97.CrossRefGoogle Scholar
  51. 51.
    Abd-Elsayed AA, Grandhi R, Sachdeva H. Effective management of trigeminal neuralgia by neurostimulation. Ochsner J Ochsner Clinic, L.L.C. and Alton Ochsner Medical Foundation. 2015;15:193–5.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Mark R. Jones
    • 1
  • Ivan Urits
    • 1
    Email author
  • Ken P. Ehrhardt
    • 2
  • John N. Cefalu
    • 2
  • Julia B. Kendrick
    • 2
  • Daniel J. Park
    • 3
  • Elyse M. Cornett
    • 2
  • Alan D. Kaye
    • 2
  • Omar Viswanath
    • 4
    • 5
    • 6
  1. 1.Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonUSA
  2. 2.Department of AnesthesiologyLouisiana State University Health Science CenterNew OrleansUSA
  3. 3.Ochsner Clinic Foundation Medical SchoolUniversity of QueenslandNew OrleansUSA
  4. 4.Valley Anesthesiology and Pain ConsultantsPhoenixUSA
  5. 5.Department of AnesthesiologyUniversity of Arizona College of Medicine-PhoenixPhoenixUSA
  6. 6.Department of AnesthesiologyCreighton University School of MedicineOmahaUSA

Personalised recommendations