Trigeminal neuralgia

Differential diagnosis

  • Malignancy – weight loss
  • Dental
  • GCA/TA
  • Migraine
  • MS – limb weakness, vision
  • Post herpetic neuralgia – previous shingles

 

Data gathering

  • Red flags
  • Others – stabbing unilateral pain, episodic, triggers (light touch, brushing, usually >50yo)
  • Examine

 

Clinical management

  • Investigations
    • MRI brain
  • Explanation
    • Irritation of hte trigeminal nerve – sometimes due to blood vessel pressing on the nerve
  • Treatment
    • Support groups
    • Carbamazepine 100mg BD and titrate every three days
  • Followup / Safety-net
    • Refer to neurology if difficult to treat, severe pain