Pain pp 583-588 | Cite as

Trigeminal Neuralgia

  • Thomas White
  • Rahul Rastogi
  • Tejinder Singh Swaran SinghEmail author


Trigeminal neuralgia (TGN) is among the most excruciating neuropathic craniofacial pain disorders. It is relatively rare in occurrence but at the same time presents significant challenges to management. Most cases of TGN fall under the category of Idiopathic TGN wherein the vast majority have evidence of a vascular malformation with an abnormal loop of artery in close proximity to the root entry zone of the trigeminal nerve root leading over time to increased compression and areas of demyelination of the nerve root. The pain is typically unilateral and has characteristic clinical features which are outlined later in the chapter. Carbamazepine is considered the drug of choice for treatment but other pharmacologic options such as Oxcarbazepine, baclofen, anti-convulsants are being increasingly used due to the potential for serious side effects with carbamazepine. For patients with Idiopathic TGN who have vascular compression, microvascular decompression is a very effective treatment modality.


Trigeminal neuralgia (TGN) Root entry zone Microvascular decompression 


  1. 1.
    Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders: 2nd edition. Cephalagia. 2004;24:9–160.CrossRefGoogle Scholar
  2. 2.
    Dielman JP, Kerklaan J, Huygen FJ, Bouma PA, Sturkenboom MC. Incidence rates and treatment of neuropathic pain conditions in the general population. Pain. 2008;137:681–8.CrossRefGoogle Scholar
  3. 3.
    Love S, Coakham HB. Trigeminal neuralgia: pathology and pathogenesis. Brain. 2001;124:2347–60.CrossRefGoogle Scholar
  4. 4.
    Bowsher D. Trigeminal neuralgia: an anatomically oriented review. Clin Anat. 1997;10:409–15.CrossRefGoogle Scholar
  5. 5.
    Cruccu G, Gronseth G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. AAN-EFNS guidelines on trigeminal neuralgia management. Eur J Neurol. 2008;15:1013–28.CrossRefGoogle Scholar
  6. 6.
    Bohnstedt BN, Tubbs RS, Cohen-Gadol AA. The use of intraoperative navigation for percutaneous procedures at the skull base including a difficult-to-access foramen ovale. Neurosurgery. 2012;70:177–80.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Thomas White
    • 1
  • Rahul Rastogi
    • 1
  • Tejinder Singh Swaran Singh
    • 1
    Email author
  1. 1.Department of AnesthesiaUniversity of Iowa Hospitals and ClinicsIowa CityUSA

Personalised recommendations