Skip to main content

A 75-Year-Old Woman with Frequent Fleeting Face Pain (Trigeminal Neuralgia)

  • Chapter
  • First Online:
Practical Chronic Pain Management


Trigeminal neuralgia (TN), also known as tic douloureux, is a rare and distinct facial pain syndrome often characterized by brief and recurrent episodes of unilateral electric-like pain accompanied by facial spasm or tic that may become recurrent and chronic. The occurrence of this condition increases with age and is more common in females. This peculiar syndrome can be triggered by mild cutaneous stimulation of “trigger zones” and typically follows the distribution of the trigeminal nerve, often the maxillary (V2) and mandibular (V3) distribution. Most cases of trigeminal neuralgia are caused by vascular compression of the trigeminal nerve, also known as classic trigeminal neuralgia. The other classification is known as painful trigeminal neuropathy and is caused by lesions other than vascular compression, such as post-herpetic neuralgia, post-traumatic trigeminal neuropathy, multiple sclerosis, and other space-occupying lesions. The clinical features of the syndrome help diagnose trigeminal neuralgia. The diagnostic criteria, as described by the International Classification of Headache Disorders, 3rd edition, include factors such as frequency, timing, distribution, and characteristics of the pain. Patients who meet the diagnostic criteria are recommended to have magnetic resonance imaging (MRI) to rule out secondary causes. Differential diagnosis includes any of the causes of secondary or painful trigeminal neuropathy, dental issues, and other uncommon causes of headache (such as cluster-tic syndrome and primary stabbing headache). Management entails pharmacologic therapy, percutaneous interventional procedures, surgery, and radiation therapy. The prognosis is variable and recurrence is common, described as waxing and waning in nature. We present a case report of TN of the maxillary and mandibular division, including background history, pathophysiology, clinical findings, diagnosis, treatment approach recommendations, and future therapies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others


  1. Hoppenfeld JD. Fundamentals of pain medicine: how to diagnose and treat your patients. Philadelphia: Wolters Kluwer Health; 2014.

    Google Scholar 

  2. Singh MK. Trigeminal Neuralgia. In: Egan RA, Editor. 2016. Retrieved 06 July 2018, from

  3. Love S, Coakham HB. Trigeminal neuralgia: pathology and pathogenesis. Brain. 2001;124:2347–60.

    Article  CAS  Google Scholar 

  4. Bajwa ZH, Ho CC, Khan SA. Trigeminal neuralgia. In: Dashe JF, Editor. 2018. Retrieved 6 July 2018, from

  5. Fromm GH, Terrence CF, Maroon JC. Trigeminal neuralgia: current concepts regarding etiology and pathogenesis. Arch Neurol. 1984;41:1204–7.

    Article  CAS  Google Scholar 

  6. Obermann M, Yoon MS, Ese D. Impaired trigeminal nociceptive processing in patients with trigeminal neuralgia. Neurology. 2007;69:835–41.

    Article  CAS  Google Scholar 

  7. Zussman BM, Moshel YA. Trigeminal Neuralgia: case report and review. JHN J. 2012;7(2).:Article 3.

    Google Scholar 

  8. Gronseth G, Cruccu G, Alksne J, Argoff C, Brainin M, Burchiel K, Nurmikko T, Zakrzewska JM. 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(15):1183–90.

    Article  CAS  Google Scholar 

  9. Swathi T. Trigeminal neuralgia - a case report with review of literature. SAJ Case Report. 2017;4:102.

    Google Scholar 

  10. Jannetta PJ. Microsurgical management of trigeminal neuralgia. Arch Neurol. 1985;42(8):800–1.

    Article  CAS  Google Scholar 

  11. Barker FG, Janetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996;334:1077–83.

    Article  Google Scholar 

  12. Young RF, Vermeulen SS, Grimm P, Blasko J, Posewitz A. Gamma Knife radiosurgery for treatment of trigeminal neuralgia, idiopathic and tumor related. Neurology. 1997;48:608–14.

    Article  CAS  Google Scholar 

  13. Scrivani SJ, Mathews ES, Maciewicz RJ. Trigeminal neuralgia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(5):527–38.

    Article  Google Scholar 

  14. Greenberg C, Papper EM. The indications for Gasserian ganglion block for trigeminal neuralgia. Anesthesiology. 1969;31:566–73.

    Article  CAS  Google Scholar 

  15. Cherian A. Trigeminal Nerve Block Technique.In: Raghavendra MR, editor. 2016. Retrieved 6 July 2018, from

  16. Nader A, Kendall MC. Dexamethasone versus triamcinolone side effects for ultrasound-guided trigeminal nerve block for the treatment of refractory typical or atypical facial pain. J Pain. 2016;17(4):S72.

    Article  Google Scholar 

  17. Guardiani E, Sadoughi B, Blitzer A, Sirois D. A new treatment paradigm for trigeminal neuralgia using Botulinum toxin type A. Laryngoscope. 2014;124:413–7.

    Article  CAS  Google Scholar 

  18. 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.

    Article  Google Scholar 

  19. Teruel A, Ram S, Kumar SK, Hariri S, Clark GT. Prevalence of hypertension in patients with trigeminal neuralgia. J Headache Pain. 2009;10(3):199–201.

    Article  Google Scholar 

  20. Lin KH, Chen YT, Fuh JL, Wang SJ. Increased risk of trigeminal neuralgia in patients with migraine: a nationwide population-based study. Cephalalgia. 2015.

    Google Scholar 

  21. Versavel M. Efficacy and safety of the novel sodium channel Blocker CNV1014802 in Trigeminal Neuralgia and Lumbosacral Radiculopathy Scientific Tracks Abstracts. J Pain Relief.

  22. Obermann M, Katsarava Z, Holle D. An update on emerging therapeutic options for the treatment of trigeminal neuralgia. Expert Opin Orphan Drugs. 2017;5(11):859–63.

    Article  CAS  Google Scholar 

  23. Spector S, Srivastava SS. A new look at sphenopalatine ganglion blocks for chronic migraine. Practical Pain Management. 2017;16:1.

    Google Scholar 

  24. Sluder G. The role of the sphenopalatine ganglion in nasal headaches. AR Elliott Publishing Company. N Y State J Med. 1908;27:8–13.

    Google Scholar 

  25. Ruskin SL. Techniques of sphenopalatine therapy for chorioretinitis. Eye Ear Nose Throat Mon. 1951;30(1):28–31.

    CAS  PubMed  Google Scholar 

  26. Yarnitsky D, Goor-Aryeh I, Bajwa ZH, Ransil BI, Cutrer FM, Sottile A, Burstein R. Possible parasympathetic contributions to peripheral and central sensitization during migraine. Headache. 2003;43(7):704–14.

    Article  Google Scholar 

  27. Bonica JJ. The management of pain with special emphasis on the use of analgesic block in diagnosis, prognosis, and therapy. Philadelphia: Lea & Febinger; 1953.

    Google Scholar 

  28. Candido KD, Massey ST, Sauer R, Darabad RR, Knezevic NN. A novel revision to the classical transnasal topical sphenopalatine ganglion block for the treatment of headache and facial pain. Pain Physician. 2013;16(6):E769–78.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Haroutunian, A., Candido, K.D., Knezevic, N.N. (2020). A 75-Year-Old Woman with Frequent Fleeting Face Pain (Trigeminal Neuralgia). In: Malik, T. (eds) Practical Chronic Pain Management. Springer, Cham.

Download citation

  • DOI:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-46674-9

  • Online ISBN: 978-3-030-46675-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics