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Trigeminal neuralgia (Aetiology (Idiopathic
COMMONEST, Neoplastic
…
Trigeminal neuralgia
Aetiology
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Neoplastic
Schwannoma, meningioma
Autoimmune
MS, skull base infiltration
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Diagnosis
History
PC/HPC
Pain (SOCRATES), associated
symptoms, recent illnesses
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-
SH
Living arrangements, occupation,
smoking, alcohol, drugs
PMH
Previous headaches, medical conditions
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Management
Medical
Phenytoin
Indication: 2L/add n
MOA: Na channel blocker
SEs: sedation, ataxia
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Baclofen
Indication: 2L/add on
MOA: GABA agonist
SE: sedation, drowsiness
Carbamazepine/oxcarbamazepine
Indication: 1L
MOA: Na channel blocker
SEs: ataxia, drowsy, drug inducer, hypo-Na;
oxy has less drug inducing effects
Lamotrigine
Indication: 2L/add on
MOA: Na channel blocker
SEs: sedation, rash
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Conservative
Information, advice, support
Avoid triggering activities
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Pathophysiology
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Mechanism
Irritation/inflammation of CN V by
a local blood vessel, causing sharp pain
Definition
Facial pain with sudden, unilateral,
severe, brief, stabbing pain in the
distribution of CN V
Clinical
presentation
Facial pain
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Character
Stabbing, shock like
Exacerbating/relieving factors
Exacerbators/triggers: cutaneous sensory stimuli
e.g. touch, shaving, eating, talking
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