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Trigeminal neuralgia

Key sources
The following summarized guidelines for the evaluation and management of trigeminal neuralgia are prepared by our editorial team based on guidelines from the European Academy of Neurology (EAN 2019).


1.Screening and diagnosis

Etiology: recognize that idiopathic trigeminal neuralgia is moderately associated with neuromuscular compression without morphological changes, whereas classical trigeminal neuralgia is highly associated with neuromuscular compression with morphological changes.
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2.Diagnostic investigations

Physical examination: do not use clinical characteristics to exclude secondary trigeminal neuralgia.

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  • MRI

3.Medical management

General principles
Attempt medical management before offering surgery for trigeminal neuralgia.
Treat patients with secondary trigeminal neuralgia similar to patients with primary trigeminal neuralgia.

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  • Management of acute exacerbations

  • First-line therapy

  • Second-line therapy

4.Nonpharmacologic interventions

Psychological support and referral: offer psychological and nursing support to patients with trigeminal neuralgia. Refer to national support groups where these are present.

5.Therapeutic procedures

Botulinum toxin injections: consider botulinum toxin type A injections as add-on therapy for medium-term treatment in patients with trigeminal neuralgia.

6.Surgical interventions

Surgical interventions: offer surgery for patients with trigeminal neuralgia after medical management. Offer surgery for patients with trigeminal neuralgia if the pain is not sufficiently controlled medically or if medical treatment is poorly tolerated and inform of the possibility at an early stage.
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