Mcphs Mmd Ii Trigeminal Neuralgia

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is a disorder of the Trigeminal Nerve (CN V) characterized by unilateral shooting facial pain

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Trigeminal Neuralgia (TN)

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is most often affected; the Ophthalmic branch is least often affected

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The Maxillary branch is most often affected; the Ophthalmic branch is least often affected

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May be referred to as “Tic Douloureux” due to distinctive facial spasms that accompany the attack

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Trigeminal Neuralgia (TN)

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Trigeminal neuralgia is rare before the age of?

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40

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If a female less than 40 shows signs of trigeminal neuralgia this should make you concerned for what?

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Multiple Sclerosis

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Peak incidence at 60-70 years of age
Slight female predominance
Right side of the face is more commonly affected than the left
Higher incidence in persons with HTN and occurs in 1-2% of people with Multiple Sclerosis

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Trigeminal Neuralgia

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Symptoms of Trigeminal Neuralgia are caused by?

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demyelination of the nerve endings prone to ectopic impulses which may transfer touch to pain fibers due to their close proximity

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The cause of demyelination, in trigeminal neuralgia, is thought to be due to

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vascular compression of the nerve root due to an aberrant loop of artery or vein

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Trigeminal Neuralgia

More Common

No cause of the symptoms can be identified other than vascular compression
No abnormal neurological findings identified

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Classical

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Classical
A. Paroxysmal attacks of pain lasting up to two minutes, affecting one or more divisions of the Trigeminal Nerve & fulfilling B & C
B. Pain has at least one of the following characteristics:
1. Intense, sharp, superficial or stabbing
2. Precipitated from trigger zones or by trigger factors
C. Attacks are stereotyped in the individual patient
D. No Clinical Neurologic Deficit
E. Not attributed to another disorder

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International Headache Society Diagnostic Criteria for Trigeminal Neuralgia

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Symptomatic
A. Paroxysmal attacks of pain lasting up to two minutes, with or without persistence of aching between paroxysms, affecting one or more divisions of the Trigeminal Nerve & fulfilling B & C
B. Pain has at least one of the following characteristics:
1. Intense, sharp, superficial or stabbing
2. Precipitated from trigger zones or by trigger factors
C. Attacks are stereotyped in the individual patient
D. A causative lesion other than vascular compression is demonstrated

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International Headache Society Diagnostic Criteria For Trigeminal Neuralgia

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History of recurrent episodes of unilateral facial pain in the distribution of CN V
Attacks may be infrequent or hundreds of times per day
Attacks are stereotyped
Generally asymptomatic between attacks
Triggers include talking, smiling, chewing, brushing teeth, shaving, wind, cold temperature

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Trigeminal Neuralgia

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The finding of this is pathognomonic for TN
Areas near the nose or mouth when stimulated results in a painful attack

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a Trigger Zone

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When performing an H and P on a patient suspected of having Trigeminal Neuralgia, what are two things that present as red flags towards an alternative diagnosis?

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Age < 40

Bilateral Presentation

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What is the first line medical therapy for Trigeminal Neuralgia?

Initial response is typically diagnostic and therapeutic.

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Carbamazepine (Tegretol)

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What is the 2nd choice option for treatment of trigeminal neuralgia?

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Phenytoin (Dilantin)