A Comprehensive Review of Trigeminal Neuralgia
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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.
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.
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.
KeywordsTrigeminal neuralgia Facial pain Chronic pain Neuropathic pain Anti-convulsant Microvascular decompression Neuromodulation
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.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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