The following forms of trigeminal neuralgia are distinguished:
- Idiopathic trigeminal neuralgia without evidence of vascular nerve compression – more common form; occurs predominantly unilaterally
- Classic trigeminal neuralgia with evidence of vascular nerve compression.
- Secondary (symptomatic) trigeminal neuralgia – a cause (e.g., multiple sclerosis (MS), space-occupying lesion in the cerebellopontine angle) may be found; rare form; occurs more often bilaterally; other pain may exist between episodes of pain. Sensory disturbances of the facial skin may also occur.
In addition, in the clinical symptomatology, trigeminal neuralgia with purely paroxysmal pain is differentiated from trigeminal neuralgia with additional continuous constant pain in the area supplied by the nerve. Classification of the subtypes of trigeminal neuralgia according to the ICHD-3.
13.1 Pain attributed to a lesion or disease of the trigeminal nerve |
13.1.1 Trigeminal neuralgia |
13.1.1.1 Classic trigeminal neuralgia |
13.1.1.1 Classic trigeminal neuralgia, purely paroxysmal (occurring with attacks) |
13.1.1.2 Classic trigeminal neuralgia with continuous pain |
13.1.1.2 Secondary trigeminal neuralgia |
13.1.1.2.1 Trigeminal neuralgia attributed to multiple sclerosis |
13.1.1.2.2 Trigeminal neuralgia attributed to space-occupying lesion |
13.1.1.2.3 Trigeminal neuralgia attributed to another cause |
13.1.1.3 Idiopathic trigeminal neuralgia |
13.1.1.3.1 Idiopathic trigeminal neuralgia, purely paroxysmal |
13.1.1.3.2 Idiopathic trigeminal neuralgia with continuous pain |
13.1.2 Painful trigeminal neuropathy |
13.1.2.1 Painful trigeminal neuropathy attributed to herpes zoster (shingles) |
13.1.2.2 Postherpetic trigeminal neuralgia |
13.1.2.3 Painful posttraumatic trigeminal neuropathy |
13.1.2.4 Painful trigeminal neuropathy attributed to another disorder |
13.1.2.5 Idiopathic painful trigeminal neuropathy. |
Classification of trigeminal neuralgia: International Headache Society (IHS) 2018 (after).
Classical trigeminal neuralgia |
Purely paroxysmal (without persistent background facial pain). Trigeminal neuralgia in which imaging or surgical intervention demonstrate vascular (vessel-related) compression (atrophy, displacement of the nerve). Mere contact is not sufficient (strictly speaking, this is equivalent to secondary trigeminal neuralgia in neurovascular (nerve-vessel) compression). Classic trigeminal neuralgia usually occurs in the second and third branches (cheek/lower jaw/chin area). Classic trigeminal neuralgia may be preceded by a phase of continuous pain in the area (pra-trigeminal neuralgia). Between paroxysms (seizure-like occurrence of a disease symptom), there is freedom from symptoms. |
With continuous pain (with persistent background facial pain). There is concomitant continuous or almost continuous pain in the affected supply area of the trigeminal nerve between attacks of classic trigeminal neuralgia. |
Idiopathic trigeminal neuralgiaNeither vascular (vessel-related) compression nor any other cause of trigeminal neuralgia can be demonstrated. |
Secondary trigeminal neuralgiaA cause of trigeminal neuralgia such as plaques of multiple sclerosis, infection, or a space-occupying lesion in the cerebellopontine angle have been demonstrated. |
Diagnostic criteria of trigeminal neuralgia.
Criteria | Description |
A |
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B |
Pain exhibits all of the following characteristics:
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C |
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D |
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