Update on trigeminal neuralgia

Trigeminal neuralgia leads to paroxysms of short-lasting but very severe pain. Between attacks, patients are usually asymptomatic, but a constant dull background pain may persist in some cases. The incidence of trigeminal neuralgia is 4.3 per 100,000 persons per year, with a slightly higher incidence for women (5.9 per 100,000) compared with men (3.4 per 100,000). There is a lack of certainty regarding the etiology and pathophysiology of trigeminal neuralgia. There are a wide range of medical and surgical treatments available. The preferred medical treatment for trigeminal neuralgia consists of anticonvulsant drugs, muscle relaxants and neuroleptic agents. Large-scaled placebo-controlled clinical trials are scarce. For patients refractory to medical therapy, Gasserian ganglion percutaneous techniques, gamma-knife surgery and microvascular decompression are the most promising invasive treatment options. Continuous scientific research works towards a better understanding of trigeminal neuralgia and has accomplished a greater insight into the underlying pathophysiological mechanisms.