Trigeminal neuralgia
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Synopsis

The annual incidence of trigeminal neuralgia is about 5 people per 100 000. It can occur at any age but is more common in people older than 50 years. It is about twice as common in women compared with men.
There are 3 types of trigeminal neuralgia: classical, secondary, and idiopathic. The 3 forms may be clinically indistinguishable. Classical is the most common, accounting for 75% of cases, while secondary and idiopathic account for 15% and 10%, respectively. Classical is caused by intracranial vascular compression of the trigeminal nerve root. Secondary is attributable to an identifiable neurologic disease, such as multiple sclerosis or benign tumors in the cerebellopontine angle. For patients with multiple sclerosis, the risk of trigeminal neuralgia is increased by a factor of 20. In idiopathic trigeminal neuralgia, no apparent cause of nerve disturbance is found.
Carbamazepine is the most common treatment for trigeminal neuralgia and is effective in more than half of patients. There are several other medications and interventional treatments available for refractory cases.
Codes
ICD10CM:G50.0 – Trigeminal neuralgia
SNOMEDCT:
31681005 – Trigeminal neuralgia
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Differential Diagnosis & Pitfalls
- Persistent idiopathic facial pain
- Hemifacial spasm
- Trigeminal neuropathy
- Glossopharyngeal neuralgia
- Paratrigeminal oculosympathetic syndrome
- Burning mouth syndrome
- Herpes zoster or postherpetic neuralgia
- Tolosa-Hunt syndrome
- Migraine
- Cluster headache
- Short-lasting unilateral neuralgiform headache with conjunctival injection (SUNCT)
- Short lasting unilateral neuralgiform headache attacks with cranial autonomic features (SUNA)
- Paroxysmal hemicranias
- Giant cell arteritis / temporal arteritis
- Dental pain
- Temporomandibular joint syndrome
- Sinus pain
- Otitis media
- Multiple sclerosis
- Intracranial tumors
- Brainstem stroke
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References
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Last Reviewed:06/20/2018
Last Updated:09/01/2020
Last Updated:09/01/2020