Trigeminal neuralgia: A symptomatic study of 126 successive patients with and without previous interventions

Abstract

1. Of 170 successive patients referred to our pain clinic as trigeminal neuralgia (TN), 44 (26%) were found to have other diagnoses. Twenty-seven percent consulted a dentist after their first attack; fifty-four patients (43%) had recurrence of TN following initial relief by one or more earlier interventional procedures. The median age at first attack was 56.5; 62% of patients were female, and 63.5% of TN right-sided. Only 3 patients had pure ophthalmic division TN, while 30% had TN affecting two or more divisions.2. Eighty-six point five percent could remember exactly what they were doing, where, and when they had their first paroxysm of TN pain. Careful questioning revealed that shooting pain was felt in the gums, but not in the teeth, i.e. is mediated by peripheral Aβ rather than by Aδ and C fibres. Five of our patients had extratrigeminal triggers for paroxysms.3. Two female patients spontaneously stated that wearing flat- rather than high-heeled shoes reduced the number or severity of attacks. Subsequent questioning of other patients revealed that flexing the head on the neck often provoked an attack, supporting vascular compression as a cause of TN.4. Response to moderate rather than very high doses of carbamazepine may be a prognostic indicator of long-term success with this form of treatment.5. Findings in this survey support the notion that TN is essentially a disorder of the central rather than the peripheral nervous system (CNS includes the oligodendroglia-sheathed juxtapontine nerve root).