Neurology · MU Sofia

36. Trigeminal neuralgia

Covers trigeminal neuralgia as a chronic, brief, stabbing facial pain of the trigeminal nerve, starting with its definition and the divisions most often affected. It then moves through the suspected pathophysiology of vascular compression, the clinical pain features and trigger factors, and the normal examination findings. The note separates classical from secondary forms, lists differential diagnoses and red flags, and ends with drug and surgical treatment options and complications.

Inside: 1 section · 1 labelled picture · 15 flashcards · 1 min

Topic 36 of 88 in the MU Sofia syllabus for Neurology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 201 words (1 min of reading), with 15 flashcards.

In this note

  1. Trigeminal neuralgia

Trigeminal neuralgia

Definition: Trigeminal neuralgia is a chronic pain disorder of the trigeminal nerve (CN V) characterized by sudden, severe, brief, stabbing facial pain in the distribution of one or more trigeminal divisions.

Anatomy (Key Point)

Most commonly affects: V2 (maxillary). V3 (mandibular )Rare in V1 alone.

Pathophysiology

  • Usually due to vascular compression of CN V root at brainstem entry zone
  • Leads to demyelination → abnormal ectopic nerve firing

Clinical Features

Pain Characteristics: Sudden, severe, electric shock–like pain. Very brief (seconds to 2 minutes). Recurrent attacks. Unilateral (almost always)

Trigger Factors: Touching face. Chewing. Talking. Brushing teeth. Cold wind

Pain-Free Intervals: Present between attacks

Examination

  • Usually normal neurological exam
  • No sensory loss in classic trigeminal neuralgia
  • If sensory deficit present → consider secondary cause

Types

1. Classical Trigeminal Neuralgia: Neurovascular compression. No structural lesion

2. Secondary Trigeminal Neuralgia: Multiple sclerosis. Tumors (CPA region). Brainstem lesions

Differential Diagnosis: Dental pain. Postherpetic neuralgia. Cluster headache. TMJ disorders

Red Flags (Suggest Secondary Cause): Bilateral pain. Sensory loss. Persistent pain (not paroxysmal). Young age (think multiple sclerosis)

Treatment

First-line: Carbamazepine (drug of choice). Oxcarbazepine

Second-line: Gabapentin. Baclofen

Surgical options: Microvascular decompression. Radiofrequency ablation. Gamma knife surgery

Complications: Chronic pain. Depression. Weight loss (due to fear of eating)

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