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