How is trigeminal neuralgia (TN) characterized?

Updated: Jul 11, 2019
  • Author: Manish K Singh, MD; Chief Editor: Robert A Egan, MD  more...
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Trigeminal neuralgia (TN), also known as tic douloureux, is a common and potentially disabling pain syndrome, the precise pathophysiology of which remains obscure. This condition has been known to drive patients with trigeminal neuralgia to the brink of suicide. Although neurologic examination findings are normal in patients with the idiopathic variety, the most common type of facial pain neuralgia, the clinical history is distinctive. Trigeminal neuralgia is characterized by unilateral pain following the sensory distribution of cranial nerve V—typically radiating to the maxillary (V2) or mandibular (V3) area in 35% of affected patients (see the image below)—often accompanied by a brief facial spasm or tic. Isolated involvement of the ophthalmic division is much less common (2.8%).

Illustration depicting the trigeminal nerve with i Illustration depicting the trigeminal nerve with its 3 main branches

Typically, the initial response to carbamazepine therapy is diagnostic and successful. Despite obtaining this satisfying early relief with medication, patients may experience breakthrough pain that requires additional drugs and, in some patients, one or more of a variety of surgical interventions.

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