Ms. W, a 43-year-old individual referred by the neurosurgical team due to facial pain, presented with sudden and incapacitating left intermittent shooting pain in the trigeminal region four months ago. Initial drug therapy trialled by her general practitioner offered only modest pain relief with significant side effects. Subsequent neurosurgical evaluation, including a magnetic resonance angiogram (MRA) indicating vascular compression of the Trigeminal ganglion, led to the recommendation of vascular decompression. Regrettably, Ms. W experienced a recurrence of her facial pain two months post-procedure.
The Pain Clinic assessment involved a thorough biopsychosocial history and examination. Ms. W's condition is characterised by the abrupt onset of unilateral electric shock-like pain lasting a few seconds, occurring up to 50 times daily. Accompanying symptoms include bloodshot eyes and tearing, manifesting in an episodic pattern every two weeks to monthly. Examination revealed pronounced allodynia in the distribution of the maxillary branch of the trigeminal nerve, consistently affecting the left cheek and jaw. The patient faces significant challenges in routine activities such as brushing teeth and eating.
- What are the potential differentials for unilateral facial pain?
- What red flag symptoms should be considered when taking a patient's history?
- How does trigeminal neuralgia (TN) differ from other facial pains in terms of characteristics?
