title: Trigeminal neuralgia (part II): Factors affecting early pharmacotherapeutic outcome.
abstract: OBJECTIVE
  We conducted a cohort study to examine demographic and clinical features associated with the pharmacotherapeutic outcome in classical trigeminal neuralgia (CTN) patients.
  
  
  METHODS
  Patients with a clinical profile indicating a diagnosis of CTN, as per the International Headache Society's published classification, were enrolled prospectively. Demographic and pain-related characteristics were carefully collected. For the purposes of the study, patients with features such as autonomic signs and longer attack duration were included. All patients were then initiated on a standardised and accepted stepped pharmacotherapeutic protocol for the management of CTN. Initial pain scores and prospectively collected pain scores from pain diaries were used to assess the treatment outcome, with a ≥50% reduction considered significant.
  
  
  RESULTS
  A total of 86 patients were seen, of whom five had an underlying disorder that could account for the pain. The study cohort therefore consisted of 81 patients, and based on attack duration these were divided into short (≤2 minutes, n = 61) and long (>2 minutes, n = 20) groups, for further analysis. The features of these patients and a discussion on the differential diagnosis have been presented in part 1 of this report. Employing an accepted stepped pharmacotherapeutic protocol for the management of CTN, significant improvement was more frequent in the short (74%) than in the long attack group (50%, p = 0.05). In the short attack group there were statistically significant associations between a poor treatment response and longer disease duration, the presence of autonomic signs and atypical pain descriptors for pain quality (p < 0.05).
  
  
  CONCLUSIONS
  This report supports previous findings that prolonged disease duration and autonomic signs are negative prognostic indicators. The present study now adds long attack duration as a further negative prognostic sign.
authors.affiliation: Rutgers School of Dental Medicine, Rutgers State University of New Jersey, USA rafael.benoliel@rutgers.edu.
authors.forename: R
authors.initials: R
authors.lastname: Benoliel
authors.affiliation: Department of Community Dentistry, The Faculty of Dentistry, Hebrew University-Hadassah, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Zini
authors.affiliation: Rutgers School of Dental Medicine, Rutgers State University of New Jersey, USA.
authors.forename: J
authors.initials: J
authors.lastname: Khan
authors.affiliation: Department of Oral Medicine, The Faculty of Dentistry, Hebrew University-Hadassah, Israel Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Israel.
authors.forename: G
authors.initials: G
authors.lastname: Almoznino
authors.affiliation: Department of Oral Medicine, The Faculty of Dentistry, Hebrew University-Hadassah, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Sharav
authors.affiliation: Department of Oral Medicine, The Faculty of Dentistry, Hebrew University-Hadassah, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Haviv
mesh_terms: D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D002220:Carbamazepine / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000078330:Oxcarbazepine; D059408:Pain Management / Q000379:methods; D016896:Treatment Outcome; D014277:Trigeminal Neuralgia / Q000188:drug therapy*
chemical_list: D018712:Analgesics, Non-Narcotic; D002220:Carbamazepine; D000078330:Oxcarbazepine
keywords: SUNA; anticonvulsants; carbamazepine; trigeminal autonomic cephalalgia