Trigeminal neuralgia (part I): Revisiting the clinical phenotype

Abstract

There are clear diagnostic criteria for CTN but often patients present with features, such as long pain attacks, that challenge such accepted criteria. In our cohort the clinical phenotype of trigeminal, neuralgiform pain with or without autonomic signs and background pain was observed across both short and long attack groups and the clinical implications of this are discussed.

Tic, Triggering, and Tearing: From CTN to SUNHA

“…The number and type of clinical phenomena in CTN and SUNHA may be dependent on disease duration and other comorbid factors, which determine the patient's profile and prognosis. At one end of the spectrum are patients with short paroxysmal attacks, moderate pain, and short disease duration, with few clinical phenomena associated with central sensitization (eg, no background pain) or no comorbidity of the hypothalamus (minimal parasympathetic dysfunction, no cranial autonomic signs [CAS], no sleep disturbances) and a good response to treatment . Clearly the pain, sleep, and hypothalamic relations are very complex but beyond the scope of this review .…”

“…In the middle are patients with longer, severe attacks, longer disease duration, increased reports of waking from sleep, background pain, and CAS. Finally, at the other end of the spectrum are patients with severe pain, long paroxysms of pain, and longer disease duration, presenting with many clinical phenomena associated with central sensitization and parasympathetic dysfunction, such as constant background pain, intense autonomic activation, a high frequency of waking, and poor response to treatment …”

“…CTN has been considered a progressive disease with a poor prognosis, with about 90% reporting increased attack frequency and severity . The duration of pain attacks can change over time and become more prolonged as well as severe . Historically, the response to carbamazepine is cited around 70% initially; by 5‐16 years the response rate is around 20%, with 44% of patients requiring drug combinations or alternative medication .…”

Supratrochlear Neuralgia: A Prospective Case Series of 15 Patients

“…First‐division trigeminal neuralgia affects a wider area over the first dermatome of the trigeminal nerve. Otherwise, trigeminal neuralgia appears as a paroxysmal electric pain lasting just a few seconds, typically provoked by innocuous stimuli …”

Surgical Options for Atypical Facial Pain Syndromes

“…11 Typical trigeminal neuralgia is often described as episodic, sharp, and shocklike in the trigeminal distribution occurring in bursts either less than 50% (type 1) or greater than 50% (type 2) of the time, triggered by non-noxious stimuli, such as speaking, eating, or brushing teeth. 12 Atypical facial pain, on the other hand, is different in quality, more often described as constant, burning, throbbing, and aching facial pain. Furthermore, this type of pain is characteristically unresponsive to anticonvulsant drugs.…”