Trigeminal neuralgia history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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History and Symptoms
Because trigeminal neuralgia is a clinical diagnosis, the patient's history is critical in the evaluation. The episodes of pain occur paroxysmally, or suddenly. To describe the pain sensation, patients describe a trigger area on the face, so sensitive that touching or even air currents can trigger an episode of pain. It affects lifestyle as it can be triggered by common activities in a patient's daily life, such as toothbrushing. Breezes, whether cold or warm, wintry weather or even light touching such as a kiss can set off an attack. The attacks are said to feel like stabbing electric shocks or shooting pain that becomes intractable. Individual attacks affect one side of the face at a time, last several seconds or longer, and repeats up to hundreds of times throughout the day. The pain also tends to occur in cycles with complete remissions lasting months or even years. 3-5% of cases are bilateral, or occurring on both sides. This normally indicates problems with both trigeminal nerves since one serves strictly the left side of the face and the other serves the right side. Pain attacks typically worsen in frequency or severity over time. A great deal of patients develop the pain in one branch, then over years the pain will travel through the other nerve branches. Patients with trigeminal neuralgia have stereotyped attacks; a change in the location, severity, or quality of the pain should alert the physician to the possibility of an alternative diagnosis.
The patient's history is also important for ruling out other causes of facial pain. Because of the association between trigeminal neuralgia and multiple sclerosis, patients should be asked about other neurologic symptoms, particularly those common in multiple sclerosis (e.g., ataxia, dizziness, focal weakness, unilateral vision changes). An evaluation for other diagnoses is indicated in younger patients, because classical trigeminal neuralgia is unusual in persons younger than 40 years. Cruccu G, Biasiotta A, Galeotti F, et al. Diagnosis of trigeminal neuralgia: a new appraisal based on clinical and neurophysiological findings. In: Cruccu G, Hallett M, eds. Brainstem Function and Dysfunction. Amsterdam, the Netherlands: Elsevier; 2006:171–186