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Trigeminal Neuralgia

Trigeminal Neuralgia is a topic covered in the 5-Minute Emergency Consult.

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  • The trigeminal nerve (cranial nerve [CN] V) innervates the face, oral mucosa, nasal mucosa, and cornea with its sensory fibers
  • Trigeminal neuralgia is also known as tic douloureux:
    • Tic = spasmodic muscular contraction or movement
    • Douloureux = painful
  • Usually occurs in patients >50 yr of age
  • Facial pain syndrome recognizable by history alone
  • Classical:
    • Paroxysmal attacks of unilateral (uncommonly bilateral) pain affecting 1 or more divisions of the trigeminal nerve
    • Has 1 of the following characteristics:
      • Superficial, sharp, or stabbing pain
      • Precipitated from trigger areas or factors
    • Lasts for <1 sec–2 min
    • Episodes are stereotyped in each individual
    • No clinically evident neurologic deficit
    • Not caused by another disorder
  • Symptomatic:
    • Same as above but a causative lesion (not vascular compression) is identified
  • Most common age group is 50–60 yr
  • Females > males


  • Mechanism of pain production remains controversial; accepted theory suggests:
    • Demyelination of CN, leading to ectopic stimulation and pain:
      • Demyelination caused by tortuous or aberrant vascular compression of nerve root
      • 80–90% of classical trigeminal neuralgia have compression
      • Superior cerebellar artery is the most common (75%)
      • Anterior inferior cerebellar artery (10%)
  • Secondary causes:
    • Herpes zoster
    • Multiple sclerosis
    • Space-occupying lesions:
      • Cerebropontine angle tumor
      • Aneurysm
      • Arteriovenous malformation

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Rosen, Peter, et al., editors. "Trigeminal Neuralgia." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307153/all/Trigeminal_Neuralgia.
Trigeminal Neuralgia. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307153/all/Trigeminal_Neuralgia. Accessed April 26, 2019.
Trigeminal Neuralgia. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307153/all/Trigeminal_Neuralgia
Trigeminal Neuralgia [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307153/all/Trigeminal_Neuralgia.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Trigeminal Neuralgia ID - 307153 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307153/all/Trigeminal_Neuralgia PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -