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Trigeminal Neuralgia

Noah M. Rosenberg, MD Reviewed 06/2018
 


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 

PHYSICAL EXAM

All exam findings typically are negative due to the paroxysmal nature of the disorder. 

DIFFERENTIAL DIAGNOSIS

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

REFERENCES

1
Wiffen PJ, Derry S, Moore RA, et al. Carbamazepine for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev.  2014;(4):CD005451. [View Abstract on OvidMedl...

ADDITIONAL READING

  • Attal N, Cruccu G, Baron R, et al; for European Federation of Neurological Societies. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neur...

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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