Natural history of trigeminal neuralgia—A hospital‐based retrospective study

Abstract

Objective The objective of this study was to assess the natural history of trigeminal neuralgia (TN) and pretrigeminal neuralgia (PTN) in a hospital‐based sample using a retrospective and descriptive study design. Methods This study followed a retrospective study design, which yielded a sample size of 216 patients who were reclassified as per the new classification and diagnostic grading for practice and research proposed by the American Academy of Neurology. Based on an in‐depth analysis of patient history and the treatments administered, a possible state of PTN prior to TN development was determined. Results TN shows a female predilection with predominantly unilateral involvement. A total of 45.83% of patients had left‐side involvement with V3 primarily affected. Additionally, 11.11% of patients did not have any clinically apparent trigger zone, while 68.05% had a single trigger zone. Twenty‐one patients were found to have suspected PTN prior to TN. The time interval between PTN onset and TN development ranged from 6 months to 6 years. The PTN pain varied, and the clinical overlap between the site of PTN and the site of future TN was 100%. Conclusion An in‐depth patient history can serve as a reliable modality for TN diagnosis. PTN should be considered as a differential diagnosis for pain of orofacial origin because of its overlapping features with other painful conditions.

Invasive and Non-Invasive Electrical Neuromodulation in Trigeminal Nerve Neuralgia: A Systematic Review and Meta-Analysis

“…Based on the aforementioned fact, trigeminal neuralgia is classified into type I and type II. The first type is characterized by pain-free periods between attacks and the second type is characterized by constant pain [ 19 , 22 - 24 ].…”

Trigeminal neuralgia and associated unwarranted dental treatment

“…When invasive measures are essential, it is extremely important for the dental surgeon to understand and recognize these situations and decide the minimum invasive procedure for management 29 . Differential diagnoses are innumerable but important and common ones include specific and non‐specific facial pains (associated with sinusitis and musculature origin), dental pain (associated with caries and easily rectified during clinical examination), TMJ disorders (not associated with any trigger zones), cluster headache and migraine (these problems are mostly associated with stressful aura rather than any acute sensory trigger), cracked tooth syndrome (diagnosed with a compression test to rule out any refractory episode as seen in TN), post‐herpetic neuralgia chronic paroxysmal hemicrania's and granulomatous arteritis (ruled out only after proper imaging like MRI) 30 …”

“…29 Differential diagnoses are innumerable but important and common ones include specific and non-specific facial pains (associated with sinusitis and musculature origin), dental pain (associated with caries and easily rectified during clinical examination), TMJ disorders (not associated with any trigger zones), cluster headache and migraine (these problems are mostly associated with stressful aura rather than any acute sensory trigger), cracked tooth syndrome (diagnosed with a compression test to rule out any refractory episode as seen in TN), post-herpetic neuralgia chronic paroxysmal hemicrania's and granulomatous arteritis (ruled out only after proper imaging like MRI). 30 The limitations of this study include the absence of use of any imaging modality for ruling out cranial causes of neuralgia and the absence of a proper definition of age as some autoimmune diseases like multiple sclerosis may also have features similar to TN pain but is mostly seen after 50 years of age.…”

Chronic Facial Pain: Trigeminal Neuralgia, Persistent Idiopathic Facial Pain, and Myofascial Pain Syndrome—An Evidence-Based Narrative Review and Etiological Hypothesis

“…The most commonly affected division is the third, mandibular, division; next is the second, maxillary, division, and least often affected is the first or ophthalmic division. However, when the pain is located near the boundary of another division of the nerve, it may seem to spread to that neighboring division [ 36 ]. Though often spontaneous, TN frequently has clear triggers such as touching a sensitive or trigger spot, brushing teeth, speaking, chewing, eating or drinking hot or cold food or liquids, with approximately 2/3 of patients having just one trigger spot or stimulus.…”