Classical and idiopathic trigeminal neuralgia

The term primary trigeminal neuralgia is used for classical and idiopathic trigeminal neuralgia as no cause other than compression of the trigeminal nerve is noted on magnetic resonance imaging in the classical cases. The shooting electrical pain is unilateral, evoked by light touch, and occurs as single or multiple episodes of pain lasting seconds to minutes. A more constant dull ache can be reported. Carbamazepine, oxcarbazepine, and other antiseizure medication used as monotherapy or polytherapy are effective. Tolerability of medications and poor quality of life leads patients to surgery. Microvascular decompression offers the longest period of freedom from pain but is associated with an 0.3% risk of mortality or other cerebral complications (0.6%). Ablative procedures typically offer periods of 2–4 years of pain relief, but all carry a high risk of sensory changes which can have a significant impact on quality of life. Multidisciplinary clinics and patient support groups are important sources of support.