Trigeminal Neuralgia

Noah M. Rosenberg, MD, MBA Reviewed 06/2020

BASICS

DESCRIPTION

A painful disorder of the sensory nucleus of the trigeminal nerve (cranial nerve [CN] V) that produces episodic, paroxysmal, severe, lancinating facial pain lasting seconds to minute...

DIAGNOSIS

HISTORY

Paroxysms of pain in the distribution of the trigeminal nerve. The trigeminal nerve has three branches and innervates the entire side of the face. They are known as ophthalmologic (V1...

TREATMENT

GENERAL MEASURES

Outpatient
Drug treatment is first line.
Invasive procedures are reserved for patients who cannot tolerate, fail to respond to, or relapse after chronic drug treatment.
Avoid st...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Regular outpatient follow-up to monitor symptoms and therapeutic failure

Patient Monitoring

Carbamazepine and/or phenytoin serum levels
If carbamazepine is prescrib...

REFERENCES

Wiffen PJ, Derry S, Moore RA, et al. Carbamazepine for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2014;(4):CD005451.

Zhang J, Yang M, Zhou M, et...

ADDITIONAL READING

Bendtsen L, Zakrzewska JM, Abbott J, et al. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol. 2019;26(6):831–849.

CODES

ICD10

G50.0 Trigeminal neuralgia
B02.22 Postherpetic trigeminal neuralgia

ICD9

350.1 Trigeminal neuralgia
053.12 Postherpetic trigeminal neuralgia

SNOMED

31681005 trigeminal neuralgia (disorder)
1797400...

CLINICAL PEARLS

Patients with TN typically have a normal physical exam.
The long-term efficacy of pharmacotherapy for TN is 40–50%.
If pharmacotherapy fails, stereotactic radiosurgery or surgical microv...

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