Trigeminal Neuralgia

Trigeminal neuralgia is characterized by severe, unilateral, paroxysmal stabbing pain affecting the face in the distribution of one of the divisions of the trigeminal nerve. The episodes of pain are brief and are triggered by innocuous physical stimuli. Typical age of onset is the sixth decade, with a female predominance. The most common cause is neurovascular compression. Other causes include multiple sclerosis and structural abnormalities in the cerebellopontine angle. The diagnosis is made clinically, but MRI can be useful in evaluation of the underlying etiology. First-line pharmacotherapy is carbamazepine or oxcarbazepine. If medical therapy fails, procedural interventions should be considered. From ablations to craniotomy, there is an array of procedural treatments available for trigeminal neuralgia. Patients should be educated on the risks and benefits of each procedure prior to pursuing treatment.