Trigeminal is 5th cranial nerve. It supplies face unilaterally through three divisions; ophthalmic, maxillary & mandibular. It never crosses the midline. Trigeminal Neuralgia is the classic neuropathic pain syndrome.

Clinical features:
It is a severe, almost exclusively unilateral, neuropathic pain located within the distribution of a trigeminal nerve, i.e. the eyes, lips, nose, scalp, forehead, and jaw. It manifests as paroxysmal high-intensity stabbing pain lasting seconds. Each attack may be followed by a refractory period, a period of relief that lasts seconds, minutes, or even hours.

To describe the pain sensation, patients may describe a trigger area on the face, so sensitive that touching or even air currents can trigger an episode of pain. It affects lifestyle as it can be triggered by common activities in a patient’s daily life, such as eating, talking, shaving and toothbrushing. Pain attacks typically worsen in frequency or severity over time. A great deal of patients develop the pain in one branch, then over the years, the pain will travel through the other nerve branches.

The diagnosis of trigeminal neuralgia is made from clinical history. No medical testing is available to confirm the diagnosis; however response to carbamazepine is considered as diagnostic by some.