Trigeminal neuralgia

File:Trigeminal Neuralgia.png

This disorder is characterized by episodes of severe facial pain along the trigeminal nerve divisions. The trigeminal nerve is a paired cranial nerve that has three major branches: the ophthalmic nerve (V₁), the maxillary nerve (V₂), and the mandibular nerve (V₃). One, two, or all three branches of the nerve may be affected. Trigeminal neuralgia most commonly involves the middle branch (the maxillary nerve or V₂) and lower branch (mandibular nerve or V₃) of the trigeminal nerve.{{cite web |title=Trigeminal Neuralgia and Hemifacial Spasm |url=http://com-neurosurgery-a2.sites.medinfo.ufl.edu/files/2012/11/trigeminal_neuralgia_brochure_for_web.pdf |publisher=UF Health Shands Hospital|date=November 2012|access-date=5 April 2021}}

An individual attack usually lasts from a few seconds to several minutes or hours, but these can repeat for hours with very short intervals between attacks. In other instances, only 4–10 attacks are experienced daily. The episodes of intense pain may occur paroxysmally. To describe the pain sensation, people often describe a trigger area on the face so sensitive that touching or even air currents can trigger an episode; however, in many people, the pain is generated spontaneously without any apparent stimulation.

It affects lifestyle as it can be triggered by common activities such as eating, talking, shaving and brushing teeth. The wind, chewing, and talking can aggravate the condition in many patients. The attacks are said, by those affected, to feel like stabbing electric shocks, burning, sharp, pressing, crushing, exploding or shooting pain that becomes intractable.

The pain also tends to occur in cycles with remissions lasting months or even years. Pain attacks are known to worsen in frequency or severity over time, in some people. Pain may migrate to other branches over time but in some people remains very stable.{{cite journal | vauthors = Bayer DB, Stenger TG | title = Trigeminal neuralgia: an overview | journal = Oral Surgery, Oral Medicine, and Oral Pathology | volume = 48 | issue = 5 | pages = 393–399 | date = November 1979 | pmid = 226915 | doi = 10.1016/0030-4220(79)90064-1 }}

Bilateral (occurring on both sides) trigeminal neuralgia is very rare except for trigeminal neuralgia caused by multiple sclerosis (MS). This normally indicates problems with both trigeminal nerves, since one nerve serves the left side of the face and the other serves the right side. Occasional reports of bilateral trigeminal neuralgia reflect successive episodes of unilateral (only one side) pain switching the side of the face rather than pain occurring simultaneously on both sides.{{cite journal | vauthors = Cruccu G, Finnerup NB, Jensen TS, Scholz J, Sindou M, Svensson P, Treede RD, Zakrzewska JM, Nurmikko T | title = Trigeminal neuralgia: New classification and diagnostic grading for practice and research | journal = Neurology | volume = 87 | issue = 2 | pages = 220–228 | date = July 2016 | pmid = 27306631 | pmc = 4940067 | doi = 10.1212/WNL.0000000000002840 }}

Rapid spreading of the pain, bilateral involvement or simultaneous participation with other major nerve trunks (such as Painful Tic Convulsif of nerves V & VII or occurrence of symptoms in the V and IX nerves) may suggest a systemic cause. Systemic causes could include multiple sclerosis or expanding cranial tumors.{{cite book| vauthors = Okeson JP |title=Bell's orofacial pains: the clinical management of orofacial pain|year=2005|publisher=Quintessence Publishing Co, Inc|isbn=0-86715-439-X|page=453|chapter-url=http://www.quintpub.com/display_detail.php3?psku=B439X|editor=Lindsay Harmon|chapter=17|url-status=live|archive-url=https://web.archive.org/web/20140112055333/http://www.quintpub.com/display_detail.php3?psku=B439X|archive-date=2014-01-12}}

The severity of the pain makes it difficult to wash the face, shave, and perform good oral hygiene. The pain has a significant impact on activities of daily living especially as those affected live in fear of when they are going to get their next attack of pain and how severe it will be. It can lead to severe depression and anxiety.{{cite journal | vauthors = Smith JG, Elias LA, Yilmaz Z, Barker S, Shah K, Shah S, Renton T | title = The psychosocial and affective burden of posttraumatic neuropathy following injuries to the trigeminal nerve | journal = Journal of Orofacial Pain | volume = 27 | issue = 4 | pages = 293–303 | year = 2013 | pmid = 24171179 | doi = 10.11607/jop.1056 | doi-access = free }}

However, not all people will have the symptoms described above; there are variants of TN, one of which is atypical trigeminal neuralgia ("trigeminal neuralgia, type 2" or trigeminal neuralgia with concomitant pain),{{cite web|url=http://www.ohsu.edu/facialpain/facial_pain-dx.shtml|archive-url=https://web.archive.org/web/20040625061701/http://www.ohsu.edu/facialpain/facial_pain-dx.shtml|url-status=dead|archive-date=June 25, 2004|title=Neurological surgery: facial pain|publisher=Oregon Health & Science University|access-date=2011-08-01}} based on a recent classification of facial pain.{{cite journal | vauthors = Burchiel KJ | title = A new classification for facial pain | journal = Neurosurgery | volume = 53 | issue = 5 | pages = 1164–1167 | date = November 2003 | pmid = 14580284 | doi = 10.1227/01.NEU.0000088806.11659.D8 | s2cid = 33538452 }} In these instances there is also a more prolonged lower severity background pain that can be present for over 50% of the time and is described more as a burning or prickling, rather than a shock.

Trigeminal pain can also occur after an attack of herpes zoster. Post-herpetic neuralgia has the same manifestations as in other parts of the body. Herpes zoster oticus typically presents with inability to move many facial muscles, pain in the ear, taste loss on the front of the tongue, dry eyes and mouth, and a vesicular rash. Less than 1% of varicella zoster infections involve the facial nerve and result in this occurring.{{cite journal | vauthors = Feller L, Khammissa RA, Fourie J, Bouckaert M, Lemmer J | title = Postherpetic Neuralgia and Trigeminal Neuralgia | journal = Pain Research and Treatment | volume = 2017 | pages = 1681765 | year = 2017 | pmid = 29359044 | pmc = 5735631 | doi = 10.1155/2017/1681765 | doi-access = free }}

Trigeminal deafferentation pain (TDP), also termed anesthesia dolorosa, or colloquially as phantom face pain, is from unintentional damage to a trigeminal nerve following attempts to fix a nerve problem surgically. This pain is usually constant with a burning sensation and numbness. TDP is very difficult to treat as further surgeries are usually ineffective and possibly detrimental to the person.{{cite web | url=https://www.facepain.org/understanding-facial-pain/diagnosis/anesthesia-dolorosa/ | title=Anesthesia Dolorosa | date=14 April 2021 | work = The Facial Pain Association }}

{{See also|Pathophysiology of nerve entrapment}}

The trigeminal nerve is a mixed cranial nerve responsible for sensory data such as tactition (pressure), thermoception (temperature), and nociception (pain) originating from the face above the jawline; it is also responsible for the motor function of the muscles of mastication, the muscles involved in chewing but not facial expression.{{cite web | vauthors = Pazhaniappan N |title=The Trigeminal Nerve (CN V) |url=https://teachmeanatomy.info/head/cranial-nerves/trigeminal-nerve/ |publisher=TeachMeAnatomy |access-date=5 April 2021 |date=15 August 2020}}

Several theories exist to explain the possible causes of this pain syndrome. It was once believed that the nerve was compressed in the opening from the inside to the outside of the skull; but leading research indicates that it is an enlarged or lengthened blood vessel – most commonly the superior cerebellar artery – compressing or throbbing against the microvasculature of the trigeminal nerve near its connection with the pons.{{cite journal | vauthors = Nurmikko TJ, Eldridge PR | title = Trigeminal neuralgia--pathophysiology, diagnosis and current treatment | journal = British Journal of Anaesthesia | volume = 87 | issue = 1 | pages = 117–132 | date = July 2001 | pmid = 11460800 | doi = 10.1093/bja/87.1.117 | doi-access = free }} Such a compression can injure the nerve's protective myelin sheath and cause erratic and hyperactive functioning of the nerve. This can lead to pain attacks at the slightest stimulation of any area served by the nerve as well as hinder the nerve's ability to shut off the pain signals after the stimulation ends. This type of injury may rarely be caused by an aneurysm (an outpouching of a blood vessel); by an arteriovenous malformation (AVM);{{cite journal | vauthors = Singh N, Bharatha A, O'Kelly C, Wallace MC, Goldstein W, Willinsky RA, Aviv RI, Symons SP | title = Intrinsic arteriovenous malformation of the trigeminal nerve | journal = The Canadian Journal of Neurological Sciences. Le Journal Canadien des Sciences Neurologiques | volume = 37 | issue = 5 | pages = 681–683 | date = September 2010 | pmid = 21059518 | doi = 10.1017/S0317167100010891 | doi-access = free }} by a tumor; such as an arachnoid cyst or meningioma in the cerebellopontine angle;{{cite journal | vauthors = Babu R, Murali R | title = Arachnoid cyst of the cerebellopontine angle manifesting as contralateral trigeminal neuralgia: case report | journal = Neurosurgery | volume = 28 | issue = 6 | pages = 886–887 | date = June 1991 | pmid = 2067614 | doi = 10.1097/00006123-199106000-00018 }} or by a traumatic event, such as a car accident.{{cite book| vauthors = Croft SM, Foreman AC |title=Whiplash injuries : the cervical acceleration/deceleration syndrome|year=2002|publisher=Williams & Wilkins|location=Baltimore|isbn=978-0-7817-2681-8|page=481|url=https://books.google.com/books?id=De5LdqgeSf4C&q=trigeminal+neuralgia+injury&pg=PA481|edition=3rd|url-status=live|archive-url=https://web.archive.org/web/20170314140758/https://books.google.com/books?id=De5LdqgeSf4C&pg=PA481&dq=trigeminal+neuralgia+injury&hl=en&sa=X&ei=O24nU5HoKIv8ywOIhYCoAw&redir_esc=y#v=onepage&q=trigeminal%20neuralgia%20injury&f=false|archive-date=2017-03-14}}

Short-term peripheral compression is often painless. Persistent compression results in local demyelination with no loss of axon potential continuity. Chronic nerve entrapment results in demyelination primarily, with progressive axonal degeneration subsequently. It is, "therefore widely accepted that trigeminal neuralgia is associated with demyelination of axons in the Gasserian ganglion, the dorsal root, or both."{{cite book| vauthors = Okeson JP |title=Bell's orofacial pains: the clinical management of orofacial pain|year=2005|publisher=Quintessence Publishing Co, Inc|isbn=0-86715-439-X|page=115|chapter-url=http://www.quintpub.com/display_detail.php3?psku=B439X|editor=Lindsay Harmon|chapter=6|url-status=live|archive-url=https://web.archive.org/web/20140112055333/http://www.quintpub.com/display_detail.php3?psku=B439X|archive-date=2014-01-12}} It has been suggested that this compression may be related to an aberrant branch of the superior cerebellar artery that lies on the trigeminal nerve. Further causes, besides an aneurysm, multiple sclerosis or cerebellopontine angle tumor, include: a posterior fossa tumor, any other expanding lesion or even brainstem diseases from strokes.

Trigeminal neuralgia is found in 3–4% of people with multiple sclerosis, according to data from seven studies.{{cite journal | vauthors = Foley PL, Vesterinen HM, Laird BJ, Sena ES, Colvin LA, Chandran S, MacLeod MR, Fallon MT | title = Prevalence and natural history of pain in adults with multiple sclerosis: systematic review and meta-analysis | journal = Pain | volume = 154 | issue = 5 | pages = 632–642 | date = May 2013 | pmid = 23318126 | doi = 10.1016/j.pain.2012.12.002 | s2cid = 25807525 }}{{cite journal | vauthors = De Santi L, Annunziata P | title = Symptomatic cranial neuralgias in multiple sclerosis: clinical features and treatment | journal = Clinical Neurology and Neurosurgery | volume = 114 | issue = 2 | pages = 101–107 | date = February 2012 | pmid = 22130044 | doi = 10.1016/j.clineuro.2011.10.044 | s2cid = 3402581 }} It has been theorized that this is due to damage to the spinal trigeminal complex.{{cite journal | vauthors = Cruccu G, Biasiotta A, Di Rezze S, Fiorelli M, Galeotti F, Innocenti P, Mameli S, Millefiorini E, Truini A | title = Trigeminal neuralgia and pain related to multiple sclerosis | journal = Pain | volume = 143 | issue = 3 | pages = 186–191 | date = June 2009 | pmid = 19171430 | doi = 10.1016/j.pain.2008.12.026 | s2cid = 24353039 | hdl = 11573/361397 }} Trigeminal pain has a similar presentation in patients with and without MS.{{cite journal | vauthors = De Simone R, Marano E, Brescia Morra V, Ranieri A, Ripa P, Esposito M, Vacca G, Bonavita V | title = A clinical comparison of trigeminal neuralgic pain in patients with and without underlying multiple sclerosis | journal = Neurological Sciences | volume = 26 | issue = S2 | pages = s150–s151 | date = May 2005 | pmid = 15926016 | doi = 10.1007/s10072-005-0431-8 | s2cid = 23024675 }}

Postherpetic neuralgia, which occurs after shingles, may cause similar symptoms if the trigeminal nerve is damaged, called Ramsay Hunt syndrome type 2.

When there is no apparent structural cause, the syndrome is called idiopathic.

Trigeminal neuralgia is diagnosed via the result of neurological and physical tests, as well as the individual's medical history. Magnetic resonance angiography can be used to detect vascular compression of the trigeminal nerve and refer patients to surgery.{{cite journal | vauthors = Bora N, Parihar P, Raj N, Shetty N, Nunna B | title = A Systematic Review of the Role of Magnetic Resonance Imaging in the Diagnosis and Detection of Neurovascular Conflict in Patients With Trigeminal Neuralgia | journal = Cureus | volume = 15 | issue = 9 | pages = e44614 | date = September 2023 | pmid = 37799230 | pmc = 10547583 | doi = 10.7759/cureus.44614 | doi-access = free }}

As with many conditions without clear physical or laboratory diagnosis, TN is often misdiagnosed, and other conditions are also frequently misdiagnosed as TN.{{cite journal | vauthors = Antonaci F, Arceri S, Rakusa M, Mitsikostas DD, Milanov I, Todorov V, Ramusino MC, Costa A | title = Pitfals in recognition and management of trigeminal neuralgia | journal = The Journal of Headache and Pain | volume = 21 | issue = 1 | pages = 82 | date = June 2020 | pmid = 32605593 | pmc = 7325374 | doi = 10.1186/s10194-020-01149-8 | doi-access = free }}{{cite journal | vauthors = Slettebø H | title = Is this really trigeminal neuralgia? Diagnostic re-evaluation of patients referred for neurosurgery | journal = Scandinavian Journal of Pain | volume = 21 | issue = 4 | pages = 788–793 | date = October 2021 | pmid = 34333890 | doi = 10.1515/sjpain-2021-0045 | doi-access = free }} A person with TN may see three or four clinicians before a firm diagnosis is made.

Temporomandibular disorder (TMD) can present similarly to TN, and differentiating between these conditions can be difficult.{{cite journal |vauthors=Drangsholt M, Truelove EL |year=2001 |title=Trigeminal neuralgia mistaken as temporomandibular disorder |url=http://www.jebdp.com/article/S1532-3382%2801%2970082-6/abstract |journal=Journal of Evidence Based Dental Practice |volume=1 |issue=1 |pages=41–50 |doi=10.1067/med.2001.116846}} Even suspected TN patients who experience brief attacks of sharp pain have had their symptoms resolve after being treated for TMD.{{cite journal | vauthors = Ceneviz C, Maloney G, Mehta N | title = Myofascial pain may mimic trigeminal neuralgia | journal = Cephalalgia | volume = 26 | issue = 7 | pages = 899–901 | date = July 2006 | pmid = 16776712 | doi = 10.1111/j.1468-2982.2006.01123.x }} TMD pain can also be triggered by movements of the tongue or facial muscles, so TN must be differentiated from masticatory pain by differentiating between the clinical characteristics of deep somatic pain and neuropathic pain. Masticatory pain will not be arrested by a conventional mandibular local anesthetic block. One quick test a dentist might perform is a conventional inferior dental local anesthetic block. If the pain is in the treated branch, the block will not arrest masticatory pain but will alleviate TN pain.{{cite web |date=9 December 2020 |title=Trigeminal Nerve Block |url=http://emedicine.medscape.com/article/2040595-overview |url-status=live |archive-url=https://web.archive.org/web/20151026075104/http://emedicine.medscape.com/article/2040595-overview |archive-date=26 October 2015 |access-date=20 November 2015 |website=MedScape |vauthors=Cherian A, Maroju NK |veditors=Raghavendra M}}

There is evidence that points towards the need to quickly treat and diagnose TN. It is thought that the longer a patient has TN, the harder it may be to reverse the neural pathways associated with the pain.{{citation needed|date=August 2021}}

• The anticonvulsant carbamazepine is the first line treatment; second line medications include baclofen, lamotrigine, oxcarbazepine, phenytoin, topiramate, gabapentin and pregabalin. Uncontrolled trials have suggested that clonazepam and lidocaine may be effective.{{cite journal | vauthors = Sindrup SH, Jensen TS | title = Pharmacotherapy of trigeminal neuralgia | journal = The Clinical Journal of Pain | volume = 18 | issue = 1 | pages = 22–27 | year = 2002 | pmid = 11803299 | doi = 10.1097/00002508-200201000-00004 | s2cid = 24407923 }}
• Antidepressant medications, such as amitriptyline have shown good efficacy in treating trigeminal neuralgia, especially if combined with an anti-convulsant drug such as pregabalin.{{cite journal| vauthors = Ahmed OL, Akinyele OA, Akindayo OA, Bamidele K |title=Management of Trigeminal Neuralgia using Amitriptyline and Pregablin combination Therapy|url=http://www.bioline.org.br/pdf?md12033|journal=African Journal of Biomedical Research|date=September 2012|volume=15|number=1|pages=201–203|display-authors=etal|url-status=live|archive-url=https://web.archive.org/web/20160822053222/http://www.bioline.org.br/pdf?md12033|archive-date=2016-08-22}}
• There is some evidence that duloxetine can also be used in some cases of neuropathic pain, especially in patients with major depressive disorder{{cite journal | vauthors = Hsu CC, Chang CW, Peng CH, Liang CS | title = Rapid Management of Trigeminal Neuralgia and Comorbid Major Depressive Disorder With Duloxetine | journal = The Annals of Pharmacotherapy | volume = 48 | issue = 8 | pages = 1090–1092 | date = August 2014 | pmid = 24788987 | doi = 10.1177/1060028014532789 | s2cid = 38592913 }} as it is an antidepressant. However, it should, by no means, be considered a first line therapy and should only be tried by specialist advice.{{cite journal | vauthors = Lunn MP, Hughes RA, Wiffen PJ | title = Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 1 | pages = CD007115 | date = January 2014 | pmid = 24385423 | pmc = 10711341 | doi = 10.1002/14651858.CD007115.pub3 }}
• There is controversy around opiate use such as morphine and oxycodone for treatment of TN, with varying evidence on its effectiveness for neuropathic pain. Generally, opioids are considered ineffective against TN and thus should not be prescribed.{{cite journal | vauthors = Zakrzewska JM, Linskey ME | title = Trigeminal neuralgia | journal = BMJ | volume = 348 | issue = feb17 9 | pages = g474 | date = February 2014 | pmid = 24534115 | doi = 10.1136/bmj.g474 | url = http://www.bmj.com/bmj/section-pdf/752707?path=/bmj/348/7946/Clinical_Review.full.pdf | url-status = live | s2cid = 45305211 | archive-url = https://web.archive.org/web/20161220132327/http://www.bmj.com/bmj/section-pdf/752707?path=%2Fbmj%2F348%2F7946%2FClinical_Review.full.pdf | archive-date = 20 December 2016 }}

Microvascular decompression provides freedom from pain in about 75% of patients presenting with drug-resistant trigeminal neuralgia.{{cite journal | vauthors = Holste K, Chan AY, Rolston JD, Englot DJ | title = Pain Outcomes Following Microvascular Decompression for Drug-Resistant Trigeminal Neuralgia: A Systematic Review and Meta-Analysis | journal = Neurosurgery | volume = 86 | issue = 2 | pages = 182–190 | date = February 2020 | pmid = 30892607 | pmc = 8253302 | doi = 10.1093/neuros/nyz075 }}{{cite journal | vauthors = Zakrzewska JM, Akram H | title = Neurosurgical interventions for the treatment of classical trigeminal neuralgia | journal = The Cochrane Database of Systematic Reviews | volume = 2011 | issue = 9 | pages = CD007312 | date = September 2011 | pmid = 21901707 | pmc = 8981212 | doi = 10.1002/14651858.CD007312.pub2 }}{{cite web | vauthors = Barbor M | date = 5 October 2015 | title = MVD Bests Gamma Knife for Pain in Trigeminal Neuralgia | url = http://www.medscape.com/viewarticle/852161 | archive-url = https://web.archive.org/web/20151110112736/http://www.medscape.com/viewarticle/852161 | archive-date=2015-11-10 }} While there may be pain relief after surgery, there is also a risk of adverse effects, such as facial numbness. Percutaneous radiofrequency thermorhizotomy may also be effective{{cite journal | vauthors = Sindou M, Tatli M | title = [Treatment of trigeminal neuralgia with thermorhizotomy] | journal = Neuro-Chirurgie | volume = 55 | issue = 2 | pages = 203–210 | date = April 2009 | pmid = 19303114 | doi = 10.1016/j.neuchi.2009.01.015 }} as may stereotactic radiosurgery; however the effectiveness decreases with time.{{cite journal | vauthors = Dhople AA, Adams JR, Maggio WW, Naqvi SA, Regine WF, Kwok Y | title = Long-term outcomes of Gamma Knife radiosurgery for classic trigeminal neuralgia: implications of treatment and critical review of the literature. Clinical article | journal = Journal of Neurosurgery | volume = 111 | issue = 2 | pages = 351–358 | date = August 2009 | pmid = 19326987 | doi = 10.3171/2009.2.JNS08977 }}

Surgical procedures can be separated into non-destructive and destructive:

• Microvascular decompression – this involves a small incision behind the ear and some bone removal from the area. An incision through the meninges is made to expose the nerve. Any vascular compressions of the nerve are carefully moved and a sponge-like pad is placed between the compression and nerve, stopping unwanted pulsation and allowing myelin sheath healing.{{citation needed|date=September 2020}}

All destructive procedures will cause facial numbness, post relief, as well as pain relief.

• Percutaneous techniques which all involve a needle or catheter entering the face up to the origin where the nerve splits into three divisions and then damaging this area, purposely, to produce numbness but also stop pain signals. These techniques are proven effective especially in those where other interventions have failed or in those who are medically unfit for surgery such as the elderly.
• Balloon compression – inflation of a balloon at this point causing damage and stopping pain signals.
• Glycerol injection – deposition of a corrosive liquid called glycerol at this point causes damage to the nerve to hinder pain signals.
• Radiofrequency thermocoagulation rhizotomy – application of a heated needle to damage the nerve at this point.
• Stereotactic radiosurgery is a form of radiation therapy that focuses high-power energy on a small area of the body.{{cite web| vauthors = Yi-Bin C |title=Stereotactic radiosurgery – Cyber Knife|url=https://www.nlm.nih.gov/medlineplus/ency/article/007274.htm|website=MedLine Plus|access-date=20 November 2015|url-status=live|archive-url=https://web.archive.org/web/20151121045317/https://www.nlm.nih.gov/medlineplus/ency/article/007274.htm|archive-date=21 November 2015}}

Psychological and social support has found to play a key role in the management of chronic illnesses and chronic pain conditions, such as trigeminal neuralgia. Chronic pain can cause constant frustration to an individual as well as to those around them.{{cite web| vauthors = Molitor N |title=Dr|url=http://www.apa.org/helpcenter/chronic-pain.aspx |publisher=American Psychological Association|access-date=27 June 2015|url-status=live|archive-url=https://web.archive.org/web/20150626215241/http://www.apa.org/helpcenter/chronic-pain.aspx|archive-date=26 June 2015}}

File:The Scream.jpg's The Scream has been used as a symbol of facial pain generally,{{cite journal | vauthors = Williams CG, Dellon AL, Rosson GD | title = Management of chronic facial pain | journal = Craniomaxillofacial Trauma & Reconstruction | volume = 2 | issue = 2 | pages = 67–76 | date = May 2009 | pmid = 22110799 | pmc = 3052669 | doi = 10.1055/s-0029-1202593 }} and also specifically of trigeminal neuralgia.{{cite web|title=Facial Neuralgia Resources|url=http://www.facial-neuralgia.org/default.htm|publisher=Trigeminal Neuralgia Resources / Facial Neuralgia Resources|access-date=8 May 2013|url-status=live|archive-url=https://web.archive.org/web/20130708130122/http://facial-neuralgia.org/default.htm|archive-date=8 July 2013}}]]

Trigeminal neuralgia was first described by physician John Fothergill and treated surgically by John Murray Carnochan, both of whom were graduates of the University of Edinburgh Medical School. Historically TN has been called "suicide disease" due to studies by the pioneering forefather in neurosurgery Harvey Cushing involving 123 cases of TN during 1896 and 1912. In those studies it produced intense pain, higher rates of suicidal ideation in patients with severe migraines, and links to higher rates of depression, anxiety, and sleep disorders.{{cite journal | vauthors = Adams H, Pendleton C, Latimer K, Cohen-Gadol AA, Carson BS, Quinones-Hinojosa A | title = Harvey Cushing's case series of trigeminal neuralgia at the Johns Hopkins Hospital: a surgeon's quest to advance the treatment of the 'suicide disease' | journal = Acta Neurochirurgica | volume = 153 | issue = 5 | pages = 1043–1050 | date = May 2011 | pmid = 21409517 | doi = 10.1007/s00701-011-0975-8 | s2cid = 28245294 }}{{cite web | url=https://arizonapain.com/trigeminal-neuralgia-suicide-disease/ | title=Why Trigeminal Neuralgia is Considered the "Suicide Disease" |publisher=Arizona Pain Specialists LLC | date=26 September 2021 }}{{cite journal | vauthors = Prasad S, Galetta S | title = Trigeminal neuralgia: historical notes and current concepts | journal = The Neurologist | volume = 15 | issue = 2 | pages = 87–94 | date = March 2009 | pmid = 19276786 | doi = 10.1097/NRL.0b013e3181775ac3 | s2cid = 23500191 }}

Some individuals of note with TN include:

• Four-time British Prime Minister William Gladstone is believed to have had the disease.{{cite journal | vauthors = Sack JJ |title=William Gladstone: New Studies and Perspectives. Edited by Roland Quinault, Roger Swift, and Ruth Clayton Windscheffel.Farnham: Ashgate, 2012. Pp. xviii+350. $134.95. |journal=The Journal of Modern History |volume=86 |issue=4 |pages=904–905 |language=en |doi=10.1086/678722 |date=December 2014}}
• Entrepreneur and author Melissa Seymour was diagnosed with TN in 2009 and underwent microvascular decompression surgery in a well documented case covered by magazines and newspapers which helped to raise public awareness of the illness in Australia. Seymour was subsequently made a Patron of the Trigeminal Neuralgia Association of Australia.{{cite web |url=http://womansday.ninemsn.com.au/trueconfessions/truelifestories/827292/melissa-seymour-my-perfect-life-is-over |title=Melissa Seymour: My perfect life is over |publisher=Womansday.ninemsn.com.au |date=2009-06-18 |access-date=2013-10-09 |url-status=dead |archive-url=https://web.archive.org/web/20091214172147/http://womansday.ninemsn.com.au/trueconfessions/truelifestories/827292/melissa-seymour-my-perfect-life-is-over |archive-date=2009-12-14 }}
• Salman Khan, an Indian film star, was diagnosed with TN in 2011. He underwent surgery in the US.{{cite web |url=http://www.hindustantimes.com/news-feed/archives/salman-suffering-from-the-suicide-disease/article1-737044.aspx |title=Salman suffering from the suicide disease |publisher=Hindustan Times |website=www.hindustantimes.com |date=2011-08-24 |access-date=2014-06-18 |url-status=dead |archive-url=https://web.archive.org/web/20140715123125/http://www.hindustantimes.com/news-feed/archives/salman-suffering-from-the-suicide-disease/article1-737044.aspx |archive-date=2014-07-15 }}
• All-Ireland winning Gaelic footballer Christy Toye was diagnosed with the condition in 2013. He spent five months in his bedroom at home, returned for the 2014 season and lined out in another All-Ireland final with his team.{{cite news| vauthors = Foley A |url=http://www.thescore.ie/christy-toye-donegal-1674498-Sep2014/ |title=Serious illness meant Christy Toye didn't play in 2013 but now he's set for All-Ireland final: The Donegal player has experienced a remarkable revival |work=The Score |date=16 September 2014 |access-date=16 September 2014 |url-status=dead |archive-url=https://web.archive.org/web/20141004120740/http://www.thescore.ie/christy-toye-donegal-1674498-Sep2014/ |archive-date=4 October 2014 }}
• Jim Fitzpatrick – former Member of Parliament (MP) for Poplar and Limehouse – disclosed he had trigeminal neuralgia before undergoing neurosurgery. He has openly discussed his condition at parliamentary meetings and is a prominent figure in the TNA UK charity.{{cite news|title=MP urges greater awareness of trigeminal neuralgia|url=http://news.bbc.co.uk/democracylive/hi/house_of_commons/newsid_8856000/8856344.stm|website=BBC – Democracy Live|publisher=BBC|access-date=20 November 2015|url-status=live|archive-url=https://web.archive.org/web/20151121052602/http://news.bbc.co.uk/democracylive/hi/house_of_commons/newsid_8856000/8856344.stm|archive-date=21 November 2015|date=2010-07-27}}
• Jefferson Davis – President of the Confederate States of America{{cite web |url=https://www.senate.gov/artandhistory/history/minute/Jefferson_Davis_Farewell.htm |title=U.S. Senate: Jefferson Davis' Farewell |access-date=2011-06-09 |url-status=live |archive-url=https://web.archive.org/web/20110301111146/https://www.senate.gov/artandhistory/history/minute/Jefferson_Davis_Farewell.htm |archive-date=2011-03-01 }}
• Charles Sanders Peirce – American philosopher, scientist and father of pragmatism.{{cite book | vauthors = Brent J | title = Charles Sanders Peirce: A Life | location = Bloomington | publisher = Indiana University Press | date = 1993 | pages = 39–40 }}
• Gloria Steinem – American feminist, journalist, and social and political activist{{cite news| vauthors = Gorney C |title=Gloria|url=https://www.motherjones.com/politics/1995/11/gloria|newspaper=Mother Jones|date=November–December 1995|access-date=July 1, 2016|url-status=live|archive-url=https://web.archive.org/web/20160729073134/https://www.motherjones.com/politics/1995/11/gloria|archive-date=July 29, 2016}}
• Anneli van Rooyen, Afrikaans singer-songwriter popular during the 1980s and 1990s, was diagnosed with atypical trigeminal neuralgia in 2004. During surgical therapy directed at alleviating the condition performed in 2007, Van Rooyen had permanent nerve damage, resulting in her near-complete retirement from performing.{{Cite web|url=http://www.channel24.co.za/News/Local/Anneli-van-Rooyens-road-to-recovery-20110826|title=Anneli van Rooyen's road to recovery|access-date=2016-09-12|url-status=live|archive-url=https://web.archive.org/web/20170305172100/http://www.channel24.co.za/News/Local/Anneli-van-Rooyens-road-to-recovery-20110826|archive-date=2017-03-05|date=2011-08-26 | work = News24 }}
• H.R., singer of hardcore punk band Bad Brains{{Cite news|title=Hardcore legend HR of Bad Brains to undergo brain surgery|url=https://www.theguardian.com/music/2017/feb/03/hr-bad-brains-surgery|newspaper=The Guardian|access-date=2017-03-02|url-status=live|archive-url=https://web.archive.org/web/20170302001331/https://www.theguardian.com/music/2017/feb/03/hr-bad-brains-surgery|archive-date=2017-03-02|date=2017-02-03| author = Guardian Music }}
• Aneeta Prem, British author, human rights campaigner, magistrate and the founder and president of Freedom Charity. Aneeta's experience of bilateral TN began in 2010, with severe pain and resulting sleep deprivation. Her condition remained undiagnosed until 2017. MVD Surgery to ameliorate the pain on the right-hand side was performed at UCHL in December 2019.{{Cite web|url=https://emailsystem.tna.org.uk/t/ViewEmail/t/602CF56A5B0333492540EF23F30FEDED|title=The latest news from TNA UK|access-date=2020-09-23|date=2020-06-01}}{{Dead link|date=November 2023 |bot=InternetArchiveBot |fix-attempted=yes }}
• Travis Barker, drummer of rock band Blink-182{{Cite web |date=February 5, 2019|title=Blink 182 Drummer Travis Barker Uses CBD to Treat Rare Condition: "I Love CBD"|url=https://www.vaporvanity.com/travis-barker-blink-182-cbd-treats-rare-condition/ |access-date=2021-02-11 |website=vaporvanity}}
• Karel Heřmánek, Czech actor.{{cite news |last1=Voska|first1=Michal|last2=Goth|first2=Jindřich|title=Zemřel herec Karel Heřmánek, na střelnici obrátil zbraň proti sobě |url=https://www.idnes.cz/kultura/divadlo/karel-hermanek.A240825_083630_domaci_ivos |website=iDNES.cz|date=25 August 2024 |language=cs|access-date=25 August 2024|publisher=Mafra}}

• Atypical trigeminal neuralgia
• Cluster headache
• Microvascular decompression
• Nerve compression syndrome
• Nerve decompression
• Trigeminal nerve
• Trigeminal trophic syndrome

{{Reflist}}

• [https://www.nhs.uk/conditions/trigeminal-neuralgia/ Trigeminal Neuralgia at NHS Choices]

{{PNS diseases of the nervous system}}

{{Headache}}

{{Medical resources

| DiseasesDB = 13363

| ICD10 = {{ICD10|G|50|0|g|50}}, G44.847

| ICD9 = {{ICD9|350.1}}

| ICDO =

| OMIM =

| MedlinePlus = 000742

| eMedicineSubj = emerg

| eMedicineTopic = 617

| MeshID = D014277

}}

{{Authority control}}

{{DEFAULTSORT:Trigeminal Neuralgia}}

Category:Neurocutaneous conditions

Category:Pain

Category:Rare diseases

Category:Wikipedia neurology articles ready to translate

Category:Trigeminal nerve disorders

Category:Wikipedia medicine articles ready to translate