Clinical Review

Trigeminal neuralgia and its management

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39085.614792.BE (Published 25 January 2007) Cite this as: BMJ 2007;334:201
  1. Luke Bennetto, honorary clinical research fellow1,
  2. Nikunj K Patel, consultant neurosurgeon2,
  3. Geraint Fuller, consultant neurologist3
  1. 1Institute of Clinical Neurosciences, University of Bristol, Frenchay Hospital, Bristol BS16 1LE
  2. 2Department of Neurosurgery, Frenchay Hospital
  3. 3Gloucester Royal Hospital, Gloucester GL1 3NN
  1. Correspondence to: G Fuller geraint.fuller{at}glos.nhs.uk

    Trigeminal neuralgia is a severe unilateral paroxysmal facial pain, often described by patients as the “the world's worst pain.”

    Summary points

    • Trigeminal neuralgia is a rare but characteristic pain syndrome

    • Most cases are still referred to as idiopathic, although many are associated with vascular compression of the trigeminal nerve

    • A minority of cases are symptomatic of multiple sclerosis or nerve compression by tumour

    • The condition is variable and patients may have just one episode

    • Most patients respond well to drugs; carbamazepine is usually the first line treatment

    • If drug treatment fails or is not tolerated, surgical treatments are available

    • Ablative surgical treatments are associated with facial sensory loss, almost no risk of severe complications or death, and a high rate of pain recurrence; microvascular decompression has a risk of severe complications or death, albeit very low, and a lower relapse rate

    How common is trigeminal neuralgia?

    The diagnosis is made by general practitioners in 27 per 100 000 people each year1 in the United Kingdom. However, previous population based studies with a strict case definition estimated the rate to be 4-13 per 100 000 people each year.2 3 Almost twice as many women are affected as men.3 The incidence gradually increases with age and is rare below 40.

    If it is uncommon why do I need to read this?

    The condition causes severe pain, which responds poorly to analgesics, but when recognised it can be treated. The pathophysiology of trigeminal neuralgia is becoming clearer. A wide range of medical and surgical treatments has been developed and introduced, usually without randomised clinical trials. As a result, uncertainty remains about how best to use the available treatments.

    Data sources and selection criteria

    We searched Medline, National Institute for Health and Clinical Excellence (NICE), and Cochrane databases using the terms “trigeminal neuralgia”, “tic douloureux”, and “facial pain”. All related articles from the NICE and Cochrane databases were obtained. We searched Medline citation lists by title …

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