What is trigeminal neuralgia?
Trigeminal neuralgia is intractable neuropathic pain relating to the trigeminal nerve, the nerve which relays sensory impulses from the face. Patient will commonly describe severe shooting pains in one or more distributions of the trigeminal nerve, not responding to over the counter medications and unpredictable in nature.
Trigeminal neuralgia may be caused by underlying conditions (e.g. multiple sclerosis, shingles - known as post-herpetic neuralgia) but is often idiopathic (no identified cause). Mr Elledge will commonly ask for cross-sectional imaging to see whether there is any neurovascular conflict with the nerve (pressure from an adjacent blood vessel causing the nerve to "short circuit" due to loss of the protective covering). This may enable patients to be candidates for nerve decompression surgery, but often treatment is medical with anticonvulsant drugs (e.g carbamazepine) which can be titrated up slowly to response.
In a minority of cases where mono therapy is not successful, combinations of drugs may be required, with close monitoring.
