Trigeminal neuralgia

Trigeminal neuralgia (TN), also known as tic douloureux or Fothergill's disease, is a chronic pain condition affecting the trigeminal nerve (cranial nerve V), which is responsible for carrying sensation from the face to the brain. It is characterized by sudden, severe, brief, stabbing, recurrent episodes of unilateral facial pain in the distribution of one or more branches of the trigeminal nerve, most commonly the maxillary (V2) and mandibular (V3) divisions. The pain is often described as electric shock-like and can be triggered by everyday activities such as eating, talking, brushing teeth, touching the face, or even a light breeze. Episodes may last from a fraction of a second to about two minutes and can occur in rapid succession. Between attacks, patients may be pain-free, though some individuals develop a continuous background aching or burning pain. Trigeminal neuralgia is classified into classical (formerly 'typical'), secondary, and idiopathic forms. Classical TN is most often caused by neurovascular compression of the trigeminal nerve root near the brainstem, typically by the superior cerebellar artery. Secondary TN may result from an underlying condition such as multiple sclerosis or a cerebellopontine angle tumor. The condition predominantly affects adults, with onset typically after age 50, and is slightly more common in women than men. The right side of the face is affected more frequently than the left. First-line treatment is pharmacological, with carbamazepine and oxcarbazepine being the most established and effective medications for reducing the frequency and severity of attacks. Other medications such as baclofen, lamotrigine, and gabapentin may be used as adjuncts or alternatives. When medical therapy fails or becomes intolerable due to side effects, surgical options are available. These include microvascular decompression (MVD), which addresses the underlying neurovascular compression and offers the highest rate of long-term pain relief; percutaneous procedures such as balloon compression, glycerol rhizolysis, or radiofrequency thermocoagulation of the Gasserian ganglion; and stereotactic radiosurgery (Gamma Knife). The choice of treatment depends on the patient's age, overall health, type of TN, and response to prior therapies.

Data sourced from FDA regulatory filings and ClinicalTrials.gov. Updated periodically.

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