Trigeminal neuralgia (TGN; synonyms: Facial trigeminal neuralgia; Supraorbital neuralgia; Tic douloureux; Trigeminal neuropathy; ICD-10 G50.0: Trigeminal neuralgia) is a type of facial pain. It is a usually unilateral recurrent facial pain associated with sudden onset, tearing, and burning attacks of pain.
Trigeminal neuralgia and trigeminal neuropathy are part of the orofacial pain syndrome.
Trigeminal neuralgia is characterized by attacks of pain in the area supplied by one or more branches of the trigeminal nerve, which may last from a few seconds to a maximum of 2 minutes. The trigeminal nerve divides into three main branches, of which the second and/or third branch (cheek/lower jaw/chin area) are most commonly affected. Bilateral trigeminal neuralgia is rare (3% of cases).
The pain attacks may occur several times a day for weeks or months. They occur triggered by stimuli such as chewing or brushing teeth, but also from complete rest. In between, there are phases that are free of pain attacks.
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, 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.
Sex ratio: Women are affected slightly more often than men.
Frequency peak: Idiopathic trigeminal neuralgia first appears predominantly after the age of 40. Symptomatic trigeminal neuralgia occurs for the first time predominantly before the age of 40. The incidence increases with age.
The prevalence (frequency of disease) is 0.16-0.30%. The incidence (frequency of new cases) for idiopathic trigeminal neuralgia is about 5.9 cases per 100,000 inhabitants per year in women and about 3.4 cases per 100,000 inhabitants per year in men (in Germany).
Course and prognosis: The pain occurs suddenly and is very severe. Sufferers rank the pain on a pain scale of 0 (no pain) to 10 of 10. Approximately 30% of sufferers have only one episode of pain, 19% have two, 24% have three, and 28% have 4-11 episodes of pain lasting between one day and 4 years. In 65%, the next episode of pain occurs within 5 years and in 23% after more than 10 years.
In the setting of idiopathic trigeminal neuralgia, a dull background headache may be persistently felt after prolonged disease duration.
Comorbidity (concomitant disease): the disease is common in persons with multiple sclerosis (MS) (approximately three in one hundred persons who have trigeminal neuralgia also have MS).
