TN is a disorder with multiple "faces" or presentations. The classification of TN has recently caught up with the clinical reality, and we have subgroups based on background pain and NVC. In addition, we are aware that the 2-minute cutoff for pain duration needs investigating along with the presence of lacrimation and sensory changes. Could these make up future subgroups? The enormous advances in imaging and genetics may contribute significantly to our understanding of TN. Certainly, a reliable and representative animal model for TN would be advantageous. This may assist in drug development; we are in need of new, efficient drugs with minimal side effects. Our present armamentarium is "old" and needs replenishing.
Most studies collect data on pain and side effects. However, very few collect data on the impact of the disorder and its treatment on physical functioning, emotional status, and patient satisfaction. This is a disorder that can cause depression and suicidal thoughts, and such outcomes are important. It is important to standardize outcome measures used for pain relief, pain intensity, and the rarely collected frequency of pain episodes.
The definition of ITN is a fascinating opportunity. What causes the pain? In the absence of a clear lesion, can it be considered a full neuropathic pain condition? This is an exciting time in the research of TN.
CTN, classical trigeminal neuralgia; ICHD, International Classification of Headache Disorders; IHS, International Headache Society; ITN, idiopathic trigeminal neuralgia; NVC, neurovascular compression; QoL, quality of life; STN, symptomatic trigeminal neuralgia; TN, trigeminal neuralgia.
Headache. 2021;61(6):817-837. © 2021 Blackwell Publishing