Trigeminal neuralgia

Trigeminal neuralgia is a rare, episodic facial pain that is unilateral, electric shock-like, and provoked by light touch. At first, it is often mistaken as a tooth problem owing to its presentation in the two lower branches of the trigeminal nerve. Patients may undergo unnecessary—and sometimes irreversible—dental treatment before the condition isrecognised. Initially, a small dose of an antiepileptic drug (such as carbamazepine) rather than any analgesic drug can provide excellent pain relief. However, up to 10% of patients will not respond to antiepileptic drugs,1 and in rare instances trigeminal neuralgia can be secondary to a brain tumour, multiple sclerosis, or vascular anomalies, which will be identified only on neuroimaging.2 If quality of life becomes impaired and symptoms are uncontrolled with drug treatment, patientsshould be referred to a neurosurgeon for consideration of surgical management. Studies in Europe have shown that trigeminal neuralgia results in considerable interference with activities of daily living that is comparable to other neuropathic pain conditions,3 and could lead to suicide.4 This review aims to highlight the key features of trigeminal neuralgia and familiarise readers with both the medical and surgical management of this condition, which remains based on limited evidence and expert opinion