TRIGEMINAL NEURALGIA

Tic de la Roux

Trigeminal Neuralgia refers to a pattern of debilitating facial neuropathy. It’s sometimes called the “suicide disease.” It’s so painful that suicide is the only escape.

Symptoms?

It causes short bursts of shooting, unilateral pains of the face. The pain will follow a branch of CN 5 (forehead, cheeks or jaw). Usually brought on by chewing, talking, brushing teeth or even touching the cheek.  Patients will be pain-free in between attacks.

Typical patient profile?

Over the age of 50, more than likely female. 

MOA?

Not well understood. Sometimes there is an obvious cause, such as when a mass compresses one of the trigeminal roots. One of the most common “compressors” is the Superior Cerebellar Artery, which courses by the Trigeminal system. MS can cause it too. 

Diagnosis?

The dx is made with history and physical alone. 

Treatment?

Anticonvulsants like Carbamazepine or Oxcarbazepine, which has less side effects than Carbamazepine (diplopia, ataxia, SIADH, agranulocytosis, aplastic anemia, hepatotoxicity, teratogenesis, CYP450 induction).