Editing Trigeminal neuralgia (section)

{{Short description|Neurological pain disorder}}
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{{Infobox medical condition (new)
| name          = Trigeminal neuralgia
| image         = Gray778.png
| caption       = The [[trigeminal nerve]] and its three major divisions (shown in yellow): the [[ophthalmic nerve]] (V<sub>1</sub>), the [[maxillary nerve]] (V<sub>2</sub>), and the [[mandibular nerve]] (V<sub>3</sub>)
| field         = [[Neurology]]
| synonyms      = Tic douloureux,<ref name=NIH2015/> prosopalgia,<ref name=Hackley1869>{{cite book| vauthors = Hackley CE |title=A text-book of practical medicine|year=1869|publisher=D. Appleton & Co|page=[https://archive.org/details/atextbookpracti00hackgoog/page/n300 292]|url=https://archive.org/details/atextbookpracti00hackgoog|quote=prosopalgia.|access-date=2011-08-01}}</ref> Fothergill's disease,<ref name=Bagheri2004>{{cite journal | vauthors = Bagheri SC, Farhidvash F, Perciaccante VJ | title = Diagnosis and treatment of patients with trigeminal neuralgia | journal = Journal of the American Dental Association | volume = 135 | issue = 12 | pages = 1713–1717 | date = December 2004 | pmid = 15646605 | doi = 10.14219/jada.archive.2004.0124 | url = http://jada.ada.org/cgi/content/full/135/12/1713 | url-status = dead | access-date = 2011-08-01 | archive-url = https://archive.today/20120711144557/http://jada.ada.org/cgi/content/full/135/12/1713 | archive-date = July 11, 2012 | url-access = subscription }}</ref>
| symptoms      = '''Typical''': episodes of severe, sudden, shock-like pain in one side of the face that lasts for seconds to minutes<ref name=NIH2015/><br />'''Atypical''': constant burning pain<ref name=NIH2015/>
| complications = [[depression (mood)|Depression]]<ref name=Okeson2005/>
| onset         = > 50 years old<ref name=NIH2015/>
| duration      = 
| types         = Typical and [[atypical trigeminal neuralgia]]<ref name=NIH2015/>
| causes        = Believed to be due to problems with [[myelin]] of [[trigeminal nerve]]<ref name=NIH2015/><ref name=Ob2010/>
| risks         = 
| diagnosis     = Based on symptoms<ref name=NIH2015/>
| differential  = [[Postherpetic neuralgia]]<ref name=NIH2015/>
| prevention    = 
| treatment     = Medication, surgery<ref name=NIH2015/>
| medication    = [[Carbamazepine]], [[oxcarbazepine]]<ref name=Ob2010/>
| prognosis     = 80% improve with initial treatment<ref name=Ob2010/>
| frequency     = 1 in 8,000 people per year<ref name=NIH2015/>
| deaths        = 
}}
<!-- Definition and symptoms -->

'''Trigeminal neuralgia''' ('''TN''' or '''TGN'''), also called '''Fothergill disease''', '''tic douloureux''', '''trifacial neuralgia''', is a [[chronic pain|long-term pain]] disorder that affects the [[trigeminal nerve]],<ref>{{cite web | url=https://rarediseases.org/rare-diseases/trigeminal-neuralgia/ | title=Trigeminal Neuralgia | publisher = National Organization for Rare Disorders, Inc. | date = 26 February 2014 }}</ref><ref name=NIH2015>{{cite web|title=Trigeminal Neuralgia Fact Sheet|url=https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Trigeminal-Neuralgia-Fact-Sheet|website=NINDS|publisher=National Institutes of Health|access-date=5 April 2021|date=17 March 2020}}</ref> the nerve responsible for sensation in the face and motor functions such as biting and chewing. It is a form of [[neuropathic pain]].<ref name=":0">{{cite journal | vauthors = Cruccu G, Di Stefano G, Truini A | title = Trigeminal Neuralgia | journal = The New England Journal of Medicine | volume = 383 | issue = 8 | pages = 754–762 | date = August 2020 | pmid = 32813951 | doi = 10.1056/NEJMra1914484 | veditors = Ropper AH | s2cid = 221201036 }}</ref> There are two main types: typical and [[atypical trigeminal neuralgia]].<ref name=NIH2015/>

The typical form results in episodes of severe, sudden, shock-like pain in one side of the face that lasts for seconds to a few minutes. Groups of these episodes can occur over a few hours. The atypical form results in a constant burning pain that is less severe. Episodes may be triggered by any touch to the face.<ref name=NIH2015/> Both forms may occur in the same person. Pain from the disease has been linked to mental health issues, especially [[depression (mood)|depression]].<ref name=Okeson2005>{{cite book| vauthors = Okeson JP |title=Bell's orofacial pains: the clinical management of orofacial pain|year=2005|publisher=Quintessence Publishing Co, Inc|isbn=0-86715-439-X|page=114|chapter-url=http://www.quintpub.com/display_detail.php3?psku=B439X|editor=Lindsay Harmon|chapter=6|url-status=live|archive-url=https://web.archive.org/web/20140112055333/http://www.quintpub.com/display_detail.php3?psku=B439X|archive-date=2014-01-12}}</ref> <!-- Cause and diagnosis -->

The exact cause is unknown, but believed to involve loss of the [[myelin]] of the trigeminal nerve.<ref name="Ob2010" /> This might occur due to [[Nerve compression syndrome|nerve compression]] from a [[blood vessel]] as the nerve exits the [[brain stem]], [[multiple sclerosis]], [[stroke]], or trauma. Less common causes include a [[tumor]] or [[arteriovenous malformation]]. It is a type of [[Neuropathy|nerve pain]]. Diagnosis is typically based on the symptoms, after ruling out other possible causes such as [[postherpetic neuralgia]].<ref name=":0" /><ref name="NIH2015" />

<!-- Management -->
Treatment includes medication or surgery. The anticonvulsant [[carbamazepine]] or [[oxcarbazepine]] is usually the initial treatment, and is effective in about 90% of people.<ref name=":0" /> Side effects are frequently experienced that necessitate drug withdrawal in as many as 23% of patients.<ref name=":0" /> Other options include [[lamotrigine]], [[baclofen]], [[gabapentin]], [[amitriptyline]] and [[pimozide]].<ref name=Ob2010/> [[Opioids]] are not usually effective in the typical form. In those who do not improve or become resistant to other measures, a number of types of surgery may be tried.<ref name=Ob2010>{{cite journal | vauthors = Obermann M | title = Treatment options in trigeminal neuralgia | journal = Therapeutic Advances in Neurological Disorders | volume = 3 | issue = 2 | pages = 107–115 | date = March 2010 | pmid = 21179603 | pmc = 3002644 | doi = 10.1177/1756285609359317 }}</ref><ref name=NIH2015/>

<!-- Epidemiology and history -->
It is estimated that trigeminal neuralgia affects around 0.03% to 0.3% of people around the world with a female over-representation around a 3:1 ratio between women and men.<ref>{{cite journal | vauthors = Araya EI, Claudino RF, Piovesan EJ, Chichorro JG | title = Trigeminal Neuralgia: Basic and Clinical Aspects | journal = Current Neuropharmacology | volume = 18 | issue = 2 | pages = 109–119 | date = 2020-01-23 | pmid = 31608834 | pmc = 7324879 | doi = 10.2174/1570159X17666191010094350 }}</ref> It usually begins in people over 50 years old, but can occur at any age.<ref name=NIH2015/> The condition was first described in detail in 1773 by [[John Fothergill (physician)|John Fothergill]].<ref>{{cite journal | vauthors = Prasad S, Galetta S | title = Trigeminal neuralgia: historical notes and current concepts | journal = The Neurologist | volume = 15 | issue = 2 | pages = 87–94 | date = March 2009 | pmid = 19276786 | doi = 10.1097/nrl.0b013e3181775ac3 | s2cid = 23500191 }}</ref>
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