Chapter 14 Diagnosis of trigeminal neuralgia: a new appraisal based on clinical and neurophysiological findings

Abstract

Publisher Summary Trigeminal neuralgia (TN) or “tic douloureux” is universally considered the best known facial pain in medical practice. The International Association for the Study of Pain (IASP) defines TN as “a sudden, usually unilateral, brief stabbing recurrent pain in the distribution of one or more branches of the fifth cranial nerve.” The disorder is more common in women than in men (female-to-male ratio of 2:3). Occasionally, trigeminal neuralgia may occur in more than one member of the same family. Trigeminal neuralgia may have no apparent cause (idiopathic, essential, or classic TN) or be secondary to multiple sclerosis (MS) or benign compressions in the posterior fossa (symptomatic TN). TN symptoms are unmistakable and usually TN is recognizable by patient history alone. Pain distribution is unilateral (bilateral TN may sometimes occur in MS) and follows the sensory distribution of the trigeminal divisions, typically radiating to the maxillary (V2) or mandibular (V3) territories. Symptomatic TN can be related to slowly growing tumors—such as cholesteatomas, meningiomas, or neurinomas of the eighth nerve—which compress the trigeminal nerve root near the dorsal root entry zone. Tumors affecting the gasserian ganglion are rarely, and neurinomas of the fifth nerve are never, associated with typical TN. Rather, they cause sensory deficits and, if present, pain is constant.