title: Trigeminal neuralgia - diagnosis and treatment.
abstract: Introduction Trigeminal neuralgia (TN) is characterized by touch-evoked unilateral brief shock-like paroxysmal pain in one or more divisions of the trigeminal nerve. In addition to the paroxysmal pain, some patients also have continuous pain. TN is divided into classical TN (CTN) and secondary TN (STN). Etiology and pathophysiology Demyelination of primary sensory trigeminal afferents in the root entry zone is the predominant pathophysiological mechanism. Most likely, demyelination paves the way for generation of ectopic impulses and ephaptic crosstalk. In a significant proportion of the patients, the demyelination is caused by a neurovascular conflict with morphological changes such as compression of the trigeminal root. However, there are also other unknown etiological factors, as only half of the CTN patients have morphological changes. STN is caused by multiple sclerosis or a space-occupying lesion affecting the trigeminal nerve. Differential diagnosis and treatment Important differential diagnoses include trigeminal autonomic cephalalgias, posttraumatic or postherpetic pain and other facial pains. First line treatment is prophylactic medication with sodium channel blockers, and second line treatment is neurosurgical intervention. Future perspectives Future studies should focus on genetics, unexplored etiological factors, sensory function, the neurosurgical outcome and complications, combination and neuromodulation treatment as well as development of new drugs with better tolerability.
authors.affiliation: 1 Danish Headache Center, Department of Neurology, Rigshospitalet - Glostrup, University of Copenhagen, Denmark.
authors.forename: Stine
authors.initials: S
authors.lastname: Maarbjerg
authors.affiliation: 2 Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Di Stefano
authors.affiliation: 1 Danish Headache Center, Department of Neurology, Rigshospitalet - Glostrup, University of Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Bendtsen
authors.affiliation: 2 Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Cruccu
mesh_terms: D006801:Humans; D014277:Trigeminal Neuralgia / Q000175:diagnosis* / Q000628:therapy*
keywords: Trigeminal neuralgia; diagnostic criteria; etiology; guidelines; pathophysiology; treatment