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Trigeminal neuralgia
Trigeminal neuralgia is an "electric" pain lasting seconds in the trigeminal territory, triggered by light touch, usually caused by a vessel compressing the nerve root — and carbamazepine is the first treatment.
Why it matters in the exam
The scenario is an older person with stabbing attacks in the cheek or jaw, lasting seconds, triggered by brushing teeth, chewing or wind, and pain-free between attacks. The tests check the first drug, the signs that point to a secondary cause (young age, bilateral pain, facial sensory loss) that should raise multiple sclerosis or a tumour, and the surgical options when drugs fail. A common distractor is an unnecessary tooth extraction or treating the pain as dental. Remember that a short trigeminal autonomic headache such as SUNCT can look similar, but it has tearing and eye redness. Post-herpetic neuralgia is a constant burning pain in the area of a previous rash, mainly in the first branch, not short attacks with a trigger zone.
Key points
- Electric pain lasting seconds in branches V2 and V3, triggered by light touch.
- The classical cause is a vessel compressing the nerve root.
- MRI for every patient; young age, bilateral pain or sensory loss suggest multiple sclerosis or tumour.
- Carbamazepine or oxcarbazepine is the first treatment.
- If drugs fail — microvascular decompression in a fit patient.
Summary table
| Aspect | Feature | Meaning |
|---|---|---|
| Pain character | Attacks of sharp "electric shock" pain lasting seconds to 2 minutes, usually in branches V2 and V3, on one side | Pain-free between attacks; a refractory period after an attack |
| Triggers | Light touch on the face, brushing teeth, chewing, talking, cold wind | The trigger zone is small and well defined |
| Classification | Classical — vascular compression of the nerve root; secondary — multiple sclerosis, cerebellopontine angle tumour; idiopathic | MRI for every patient; sensory loss or bilateral pain suggests a secondary cause |
| Drug treatment | Carbamazepine (200 to 1200 mg daily) or oxcarbazepine; second line: lamotrigine, baclofen, gabapentin | Check sodium; in HLA-B*15:02 carriers be careful with carbamazepine |
| Surgery | Microvascular decompression — the most durable result in a fit patient; alternatives: percutaneous procedures on the ganglion, radiosurgery | Suitable when drugs fail or are not tolerated |
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Sources
- EAN Guideline on Trigeminal Neuralgia, 2019 — Diagnosis, imaging and treatment
- International Classification of Headache Disorders, 3rd edition (ICHD-3), 2018 — Painful lesions of the cranial nerves
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.