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

Abstract

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.