Trigeminal Neuralgia What is it?


Sudden, severe facial pain with an electric shock-like, stabbing quality that lasts for fractions of a second to minutes. It can be triggered by touching, speaking, washing the face, shaving, brushing teeth, chewing, swallowing, or wind on the face.

Types of trigeminal neuralgia:

Classic trigeminal neuralgia: This is caused by the compression of the blood vessels around the trigeminal nerve. There are no other causes.

Secondary trigeminal neuralgia: This is caused by an underlying disease such as a tumor, an abnormal network of blood vessels connecting arteries and veins, or multiple sclerosis. Individuals may experience persistent or near-persistent pain.

Idiopathic trigeminal neuralgia: All tests show no significant abnormalities.

Painful trigeminal neuropathy: Facial pain in one or more branches of the trigeminal nerve that carries sensation from the face to the brain. The pain is usually continuous or nearly continuous and is usually characterized as a burning, squeezing, or tingling sensation. Along the branches of the trigeminal nerve, sensation is limited and touching the area can be painful. Causes are herpes zoster, postherpetic neuralgia, posttraumatic, multiple sclerosis or tumor.


  • Neurological history and examination.
  • 3-t mr imaging of trigeminal nerves using 3d ciss sequences.
  • Electrophysiological tests: blink reflex and trigeminal somatosensory evoked potential


  • First line: Carbamazepine or oxcarbazepine.
  • Second row: Lamotrigine, baclofen, pregabalin, gabapentin, topiramate, valproate.
  • Neuromodulation: Gasserian (trigeminal) ganglion stimulation, peripheral nerve stimulation, invasive motor cortex stimulation and non-invasive cortex stimulation, motor transcranial direct current stimulation (tdcs), repetitive transcranial magnetic stimulation (rtms).
  • Surgical treatment: Microvascular decompression, gamma knife radiosurgery, percutaneous operations on the gasseria ganglion, percutaneous glycerol rhizolysis, radiofrequency thermocoagulation, balloon compression.

Dr. Pravin Thomas | Consultant and Clinical Director – Headache and Interventional Headache Neurology Services | Mazumdar Shaw Medical Center, Bommasandra, Bangalore

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