Diagnosis and treatment of trigeminal neuralgia: Consensus statement from the Spanish Society of Neurology’s Headache Study Group

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Diagnosis and treatment of trigeminal neuralgia criteria see below statement.

Introduction: Trigeminal neuralgia (TN) is a chronic neuropathic pain disorder affecting one or more branches of the trigeminal nerve. Despite its relatively low global prevalence, TN is an important healthcare problem both in neurology departments and in emergency departments due to the difficulty of diagnosing and treating the condition and its significant impact on patients’ quality of life. For all these reasons, the Spanish Society of Neurology’s Headache Study Group has developed a consensus statement on the management of TN.
Development: This document was drafted by a panel of neurologists specialising in headache, who used the terminology of the International Headache Society. We analysed the published scientific evidence on the diagnosis and treatment of TN and establish practical recommendations with levels of evidence.


TN is diagnosed clinically. Patients consulting due to facial pain (whether paroxysmal or continuous) should be assessed thoroughly (history-taking and physical examination). In the ICHD-3, pain attributed to a lesion or disease of the trigeminal nerve is categorised into TN and painful trigeminal neuropathy. In turn, TN is divided into 3 main types according to pain aetiology: classical, idiopathic, or secondary. The most relevant conclusions of this review are that:

1 In patients with TN (and in the absence of contraindications), an MRI study is essential in the proper assessment of the brainstem and posterior fossa and to rule out secondary causes. To establish the presence of neurovascular compression, FIESTA, DRIVE, and CISS protocols are recommended.

2 After diagnosis of TN, the pharmacological treatment of choice should be carbamazepine, unless contraindicated. Other sodium channel blockers, such as oxcarbazepine, may be better tolerated.

3 In patients unresponsive/intolerant to a first-line drug, second-line treatment with other neuromodulators or polytherapy should be considered. In patients presenting concomitant continuous pain, such antidepressants as amitriptyline or duloxetine may be indicated. Local infiltration of botulinum toxin may be an effective alternative in non-responders or in polytherapy.

4 Surgical treatment should be considered in refractory cases.  The specific procedure should be selected based on the presence or absence of neurovascular compression, patient age, and other factors. The technique of first choice is MVD, especially in patients in whom neurovascular compression is identified.

Diagnosis and treatment of trigeminal neuralgia: Consensus statement from the Spanish Society of Neurology’s Headache Study Group


Tags: diagnosing trigeminal neuralgia, research, Trigeminal neuralgia treatment

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