Trigeminal neuralgia

What it is

Trigeminal neuralgia is paroxysms of intense stabbing, burning or electric shock type pain lasting seconds to minutes, felt in the trigeminal, that is V, nerve distribution. It is 96% unilateral, and the mandibular and maxillary divisions are involved more often than the ophthalmic division.

It can occur at any age but is more common over 50 years, and it is more common in women than in men. The cause is unknown, but it is associated with MS.

The clinical features that make the diagnosis

The pain is unilateral facial pain characterised by brief electric shock-like pains, abrupt in onset and abrupt in termination. It may be triggered by light touch or by emotion, and provoked by movement of the face in talking, eating or laughing, or by touching the skin in shaving or washing. Between attacks there are no symptoms at all. The frequency of attacks ranges from hundreds a day to remissions lasting years.

The worked cases add the daily triggers: a woman with a two week history of shooting pains across her left cheek, sometimes triggered by touching her face; and a 25-year-old lady with left sided headache of 1 minute bouts, worse with chewing and laughter, described as sparks of electric shock and worse when she applies cosmetics; the headaches come together multiple times a week and remit.

Four of those five features are in the history rather than the examination, which is why this is a diagnosis made from the history.