As with many conditions without clear physical or laboratory diagnosis,<unk>  is sometimes misdiagnosed. A<unk>  sufferer will sometimes seek the help of numerous clinicians before a firm diagnosis is made. There is evidence that points towards the need to quickly treat and diagnose<unk> . It is thought that the longer a patient suffers from<unk> , the harder it may be to reverse the neural pathways associated with the pain. The differential diagnosis includes temporomandibular disorder. Since triggering may be caused by movements of the tongue or facial muscles,<unk>  must be differentiated from masticatory pain that has the clinical characteristics of deep somatic rather than neuropathic pain. Masticatory pain will not be arrested by a conventional mandibular local anesthetic block. One quick test a dentist might perform is a conventional inferior dental local anaesthetic block, if the pain is in this branch, as it will not arrest masticatory pain but will<unk> . Medical * The anticonvulsant carbamazepine is the first line treatment; second line medications include baclofen, lamotrigine, oxcarbazepine, phenytoin, gabapentin and pregabalin. Uncontrolled trials have suggested that clonazepam and lidocaine may be effective. * Antidepressant medications, such as amitriptyline have shown good efficacy in treating<unk> , especially if combined with an anti-convulsant drug such as pregabalin. * There is some evidence that duloxetine can also be used in some cases of neuropathic pain, especially in patients with major depressive disorder as it is an antidepressant. However, it should, by no means, be considered a first line therapy and should only be tried by specialist advice. * There is controversy around opiate use such as morphine and oxycodone for treatment of<unk> , with varying evidence on its effectiveness for neuropathic pain. Generally, opioids are considered ineffective against<unk>  and thus should not be prescribed. Surgical Microvascular decompression provides freedom from pain in about 75% of patients presenting with drug-resistant<unk> . While there may be pain relief after surgery, there is also a risk of adverse effects, such as facial numbness. Percutaneous radiofrequency thermorhizotomy may also be effective as may stereotactic radiosurgery; however the effectiveness decreases with time. Surgical procedures can be separated into non-destructive and destructive: Non-destructive * Microvascular decompression – this involves a small incision behind the ear and some bone removal from the area. An incision through the meninges is made to expose the nerve. Any vascular compressions of the nerve are carefully moved and a sponge-like pad is placed between the compression and nerve, stopping unwanted pulsation and allowing myelin sheath healing. Destructive All destructive procedures will cause facial numbness, post relief, as well as pain relief. * Percutaneous techniques which all involve a needle or catheter entering the face up to the origin where the nerve splits into three divisions and then damaging this area, purposely, to produce numbness but also stop pain signals. These techniques are proven effective especially in those where other interventions have failed or in those who are medically unfit for surgery such as the elderly. * Balloon compression – inflation of a balloon at this point causing damage and stopping pain signals. * Glycerol injection – deposition of a corrosive liquid called glycerol at this point causes damage to the nerve to hinder pain signals. * Radiofrequency thermocoagulation rhizotomy – application of a heated needle to damage the nerve at this point. * Stereotactic radiosurgery is a form of radiation therapy that focuses high-power energy on a small area of the body Support Psychological and social support has found to play a key role in the management of chronic illnesses and chronic pain conditions, such as<unk> . Chronic pain can cause constant frustration to an individual as well as to those around them.
Trigeminal neuralgia
Postherpetic neuralgia
Occipital neuralgia
Cluster headache
Trigeminal autonomic cephalgia
Atypical trigeminal neuralgia
Thunderclap headache
Trigeminal trophic syndrome