Abstract
Trigeminal neuralgia (TN), also known as tic douloureux, is a rare and distinct facial pain syndrome often characterized by brief and recurrent episodes of unilateral electric-like pain accompanied by facial spasm or tic that may become recurrent and chronic. The occurrence of this condition increases with age and is more common in females. This peculiar syndrome can be triggered by mild cutaneous stimulation of “trigger zones” and typically follows the distribution of the trigeminal nerve, often the maxillary (V2) and mandibular (V3) distribution. Most cases of trigeminal neuralgia are caused by vascular compression of the trigeminal nerve, also known as classic trigeminal neuralgia. The other classification is known as painful trigeminal neuropathy and is caused by lesions other than vascular compression, such as post-herpetic neuralgia, post-traumatic trigeminal neuropathy, multiple sclerosis, and other space-occupying lesions. The clinical features of the syndrome help diagnose trigeminal neuralgia. The diagnostic criteria, as described by the International Classification of Headache Disorders, 3rd edition, include factors such as frequency, timing, distribution, and characteristics of the pain. Patients who meet the diagnostic criteria are recommended to have magnetic resonance imaging (MRI) to rule out secondary causes. Differential diagnosis includes any of the causes of secondary or painful trigeminal neuropathy, dental issues, and other uncommon causes of headache (such as cluster-tic syndrome and primary stabbing headache). Management entails pharmacologic therapy, percutaneous interventional procedures, surgery, and radiation therapy. The prognosis is variable and recurrence is common, described as waxing and waning in nature. We present a case report of TN of the maxillary and mandibular division, including background history, pathophysiology, clinical findings, diagnosis, treatment approach recommendations, and future therapies.
Keywords
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Hoppenfeld JD. Fundamentals of pain medicine: how to diagnose and treat your patients. Philadelphia: Wolters Kluwer Health; 2014.
Singh MK. Trigeminal Neuralgia. In: Egan RA, Editor. 2016. Retrieved 06 July 2018, from https://emedicine.medscape.com/article/1145144-overview.
Love S, Coakham HB. Trigeminal neuralgia: pathology and pathogenesis. Brain. 2001;124:2347–60.
Bajwa ZH, Ho CC, Khan SA. Trigeminal neuralgia. In: Dashe JF, Editor. 2018. Retrieved 6 July 2018, from https://www.uptodate.com/contents/trigeminal-neuralgia/print.
Fromm GH, Terrence CF, Maroon JC. Trigeminal neuralgia: current concepts regarding etiology and pathogenesis. Arch Neurol. 1984;41:1204–7.
Obermann M, Yoon MS, Ese D. Impaired trigeminal nociceptive processing in patients with trigeminal neuralgia. Neurology. 2007;69:835–41.
Zussman BM, Moshel YA. Trigeminal Neuralgia: case report and review. JHN J. 2012;7(2).:Article 3.
Gronseth G, Cruccu G, Alksne J, Argoff C, Brainin M, Burchiel K, Nurmikko T, Zakrzewska JM. Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology. 2008;71(15):1183–90.
Swathi T. Trigeminal neuralgia - a case report with review of literature. SAJ Case Report. 2017;4:102.
Jannetta PJ. Microsurgical management of trigeminal neuralgia. Arch Neurol. 1985;42(8):800–1.
Barker FG, Janetta PJ, Bissonette DJ, Larkins MV, Jho HD. The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med. 1996;334:1077–83.
Young RF, Vermeulen SS, Grimm P, Blasko J, Posewitz A. Gamma Knife radiosurgery for treatment of trigeminal neuralgia, idiopathic and tumor related. Neurology. 1997;48:608–14.
Scrivani SJ, Mathews ES, Maciewicz RJ. Trigeminal neuralgia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(5):527–38.
Greenberg C, Papper EM. The indications for Gasserian ganglion block for trigeminal neuralgia. Anesthesiology. 1969;31:566–73.
Cherian A. Trigeminal Nerve Block Technique.In: Raghavendra MR, editor. 2016. Retrieved 6 July 2018, from https://emedicine.medscape.com/article/2040595-technique.
Nader A, Kendall MC. Dexamethasone versus triamcinolone side effects for ultrasound-guided trigeminal nerve block for the treatment of refractory typical or atypical facial pain. J Pain. 2016;17(4):S72.
Guardiani E, Sadoughi B, Blitzer A, Sirois D. A new treatment paradigm for trigeminal neuralgia using Botulinum toxin type A. Laryngoscope. 2014;124:413–7.
Maarbjerg S, Gozalov A, Olesen J, Bendtsen L. Trigeminal neuralgia—a prospective systematic study of clinical characteristics in 158 patients. Headache. 2014;54:1574–82.
Teruel A, Ram S, Kumar SK, Hariri S, Clark GT. Prevalence of hypertension in patients with trigeminal neuralgia. J Headache Pain. 2009;10(3):199–201.
Lin KH, Chen YT, Fuh JL, Wang SJ. Increased risk of trigeminal neuralgia in patients with migraine: a nationwide population-based study. Cephalalgia. 2015.
Versavel M. Efficacy and safety of the novel sodium channel Blocker CNV1014802 in Trigeminal Neuralgia and Lumbosacral Radiculopathy Scientific Tracks Abstracts. J Pain Relief. https://doi.org/10.4172/2167-0846.S1.002.
Obermann M, Katsarava Z, Holle D. An update on emerging therapeutic options for the treatment of trigeminal neuralgia. Expert Opin Orphan Drugs. 2017;5(11):859–63. https://doi.org/10.1080/21678707.2017.1394183.
Spector S, Srivastava SS. A new look at sphenopalatine ganglion blocks for chronic migraine. Practical Pain Management. 2017;16:1.
Sluder G. The role of the sphenopalatine ganglion in nasal headaches. AR Elliott Publishing Company. N Y State J Med. 1908;27:8–13.
Ruskin SL. Techniques of sphenopalatine therapy for chorioretinitis. Eye Ear Nose Throat Mon. 1951;30(1):28–31.
Yarnitsky D, Goor-Aryeh I, Bajwa ZH, Ransil BI, Cutrer FM, Sottile A, Burstein R. Possible parasympathetic contributions to peripheral and central sensitization during migraine. Headache. 2003;43(7):704–14.
Bonica JJ. The management of pain with special emphasis on the use of analgesic block in diagnosis, prognosis, and therapy. Philadelphia: Lea & Febinger; 1953.
Candido KD, Massey ST, Sauer R, Darabad RR, Knezevic NN. A novel revision to the classical transnasal topical sphenopalatine ganglion block for the treatment of headache and facial pain. Pain Physician. 2013;16(6):E769–78.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Haroutunian, A., Candido, K.D., Knezevic, N.N. (2020). A 75-Year-Old Woman with Frequent Fleeting Face Pain (Trigeminal Neuralgia). In: Malik, T. (eds) Practical Chronic Pain Management. Springer, Cham. https://doi.org/10.1007/978-3-030-46675-6_5
Download citation
DOI: https://doi.org/10.1007/978-3-030-46675-6_5
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-46674-9
Online ISBN: 978-3-030-46675-6
eBook Packages: MedicineMedicine (R0)