Age: The average age of pain onset in trigeminal neuralgia typically is sixth decade of life, but it may occur at any age. Symptomatic or secondary trigeminal neuralgia tends to occur in younger patients.

Sex: Male-to-female ratio is 2:3.

Nature of pain: Pain is stabbing or electric shock like sensation and is typically quite severe. Pain is brief (few seconds to one to two minutes) and paroxysmal, but it may occur in volleys of multiple attacks. Pain may occur several times a day; patients typically experience no pain between episodes.

Distribution of pain: Pain is one-sided (unilateral, rarely bilateral). One or more branches of the trigeminal nerve (usually lower or midface) are involved.

Trigger points: Various triggers may commonly precipitate a pain attack. Light touch or vibration is the most evocative. Activities such as shaving, face washing, or chewing often trigger an episode. Over years, periods of remission are less and less and severity of pain increases.

Course: The disease course is usually one of clusters of attacks that wax and wane in frequency. Some patients report that their exacerbations commonly occur in fall and spring.

Causes: Some patients’ conditions are unknown, but compression of the trigeminal root entry zone by blood vessels (especially branches of the superior cerebellar arteries or venous channels) or tumors may cause pain.

Imaging Studies: Patients with characteristic history and normal neurologic examination may be treated without further workup. An MRI scan with and without contrast is essential to
rule out the presence of a tumor, arteriovenous malformation, or multiple sclerosis all of which can cause trigeminal neuralgia in a small number of patients. In addition, basal skull condition including maxillary sinusitis may mimic symptoms of trigeminal neuralgia.