A 36-year-old woman gives a 2-week history of a sharp pain lasting for a few seconds which comes on when she touches the left-hand side of her upper lip. One burst of pain can follow immediately after the preceding one. When you are taking her history, she mentions that about a month ago she consulted her GMP about a deterioration in hearing affecting her left ear.

The clinical features are strongly suggestive of Trigeminal Neuralgia. The patient’s age is a cause for concern as CTN would be extremely unusual for someone of her age. The absence of a refractory period after triggering the pain is also somewhat atypical. Therefore STN should be seriously considered. The presence of ipsilateral hearing loss raises further concerns about the possibility of a central lesion. Even if the patient were in the usual age group for CTN, this would raise the possibility of STN.

Research papers on – Latest treatment options in trigeminal neuralgia

Trigeminal neuralgia is a debilitating condition characterized by severe facial pain. The first-line treatment options for trigeminal neuralgia are pharmacological (Stefano et al., 2021). Carbamazepine and oxcarbazepine are the drugs of choice for managing trigeminal neuralgia (Szok et al., 2019; Stefano et al., 2021). These drugs are voltage-gated sodium channel blockers that stabilize hyperexcited neural membranes and inhibit repetitive firing (Stefano et al., 2021). However, they may cause sedative and cognitive side effects (Stefano et al., 2021). If the first-line drugs are ineffective or poorly tolerated, other medications such as lamotrigine, baclofen, gabapentin, pregabalin, and botulinum toxin type A can be considered (Stefano et al., 2021). Surgical interventions, such as microvascular decompression, gamma knife radiosurgery, and percutaneous rhizotomies, are available for patients who do not respond to medications or cannot tolerate them (Al-Quliti, 2015). Radiofrequency ablation is a minimally invasive procedure that has shown promising results in managing trigeminal neuralgia pain (Usman & Herbiyanto, 2022). It is important to note that treatment decisions should be based on individual patient characteristics and preferences (Stefano et al., 2021).

References:

Al-Quliti, K. (2015). Update On Neuropathic Pain Treatment For Trigeminal Neuralgia. NSJ, 2(20), 107-114. https://doi.org/10.17712/nsj.2015.2.20140501 Stefano, G., Nurmikko, T., Zakrzewska, J. (2021). Treatment Of Trigeminal Neuralgia: Pharmacological., 89-104. https://doi.org/10.1093/med/9780198871606.003.0009 Szok, D., Tajti, J., Nyári, A., Vécsei, L. (2019). Therapeutic Approaches For Peripheral and Central Neuropathic Pain. BN, (2019), 1-13. https://doi.org/10.1155/2019/8685954 Usman, N., Herbiyanto, J. (2022). Radiofrequency Ablation For Trigeminal Neuralgia Patient: a Case Report. JACR, 2(3), 342-348. https://doi.org/10.37275/jacr.v3i2.256