Representative Clinical Cases: Atypical Trigeminal Neuralgia, Type 2

Abstract

The patient is a 44-year-old woman with a history of migraine headache presenting with a 3-year history of pain in the face, described as a primary constant, dull, burning ache with superimposed periods of sharp, electric shock-like sensation predominantly in the V1 distribution unilaterally. The patient states that although she experiences mostly pain in the face, there are also periods of intermittent hypesthesia. The pain is not triggerable by light touch but is made worse by showering, washing her hair, and brushing her teeth. Shortly after the pain started, she experienced pain-free intervals of up to a few weeks, but for the last year, it has been present constantly. There is no history of multiple sclerosis, facial trauma, herpes zoster, or previous surgical treatment for facial pain. Neurological examination is normal with intact cranial nerves, no evidence of facial sensory loss, and normal temporomandibular joint mobility. Carbamazepine is prescribed which produces moderate but incomplete relief. However, she continues to have severe pain.