Case of the Month #36: Facial pain by Dr Ameana Khan & Dr Shefali Kadambande

Published: 06/02/2024

Clinical Information

Trigeminal Neuralgia (TN) originates from unilateral pathology affecting one or more branches of the trigeminal (5th) nerve, often impacting the maxillary and mandibular regions exclusively. Diagnosis relies on a detailed history, revealing unilateral facial pain with sudden onset and cessation. Described as intense, sharp, and electric shock-like pain, which may last from a fraction of a second to two minutes. Triggers include harmless mechanical stimuli or facial/oral movements, possibly accompanied by local autonomic symptoms.

  • Prevalence

TN is rare, with a UK-based survey indicating an annual incidence of 8 per 100,000 and a lifetime prevalence of 0.7 per 1000 people per year2,3.

  • Risk Factors

Include being female, advancing age (rare in those under 40), a family history of TN, hypertension, stroke, and multiple sclerosis2,3.

  • Complications

May involve depression and difficulty eating, leading to weight loss.

  • Diagnosis

Relies on a meticulous patient history and examination (general/neurological/oral-facial) due to the absence of specific diagnostic tests. Symptoms closely resemble those of other facial pain disorders.

  • Testing

MRI of the brain identifies secondary causes like tumours or multiple sclerosis affecting the trigeminal nerve, ruling out other facial disorders. High-resolution MRI is valuable for revealing compression caused by blood vessels4,5.