What are the other Names for this Condition? (Also known as/Synonyms)

• CTN (Classical Trigeminal Neuralgia)

What is Classical Trigeminal Neuralgia? (Definition/Background Information)

• Trigeminal neuralgia is chronic facial pain due to involvement of the trigeminal nerve. It can cause brief and recurrent episodes of severe to excruciating pain. The condition is generally observed in middle-aged and older adults and may occur secondary to any lesion, disease, or other factors
• When the cause of trigeminal neuralgia remains unidentified, but neurovascular compression of the trigeminal nerve root is observed, the condition is known as Classical Trigeminal Neuralgia (CTN). It is classified into the following subtypes:
  • Classical Trigeminal Neuralgia, purely Paroxysmal - here, in between two pain episodes, most individuals present no pain and remain asymptomatic
  • Classical Trigeminal Neuralgia with Concomitant Continuous Pain - here, prolonged or persistent background pain may be observed in the affected region (between two pain episodes)
• According to studies, compression by a vein is milder and produces lesser symptoms than when the compression is by an artery. Both sides of the face are not usually affected; however, when the pain is bilateral, sequential pain and not concomitant pain is present
• Imaging studies can reveal anatomical changes such as demyelination, loss of nerve cells, changes in capillaries, arterioles, and venules, and other atrophic defects. Classical Trigeminal Neuralgia may be successfully treated through medications and surgery (nerve decompression), as needed

The criteria for diagnosis of Classical Trigeminal Neuralgia as outlined by the International Headache Society (IHS) is given below:

• Recurrent paroxysms of unilateral facial pain in the distribution(s) of one or more divisions of the trigeminal nerve, with no radiation beyond the divisions, and fulfilling the criterion below:
• Demonstration on MRI or during surgery of neurovascular compression (not simply contact), with morphological changes (atrophy or displacement) in the trigeminal nerve root
• Pain has all of the following characteristics:
  • Lasting from a fraction of a second to 2 minutes; although, in a few patients, the attacks may last for more than 2 minutes
  • Severe intensity (pain can become more severe over time)
  • Electric shock-like, shooting, stabbing or sharp in quality
• Precipitated by innocuous stimuli within the affected trigeminal distribution (the physician must endeavor to confirm the same)
• Not better accounted for by another ICHD-3 diagnosis

(Source: International Headache Society Classification ICHD-3, London, United Kingdom)