Atypical Trigeminal Neuralgia

Atypical trigeminal neuralgia (ATN) is a type of neuralgia that is more heterogeneous and less defined than typical trigeminal neuralgia. The array of treatments for atypical trigeminal neuralgia includes medications, nerve blocks, and, in some instances, surgical interventions. This article will delve deeper into the nature of atypical neuralgia and its treatment approaches.
Klara Hatinova

Klara Hatinova

Klara is postgraduate researcher in experimental psychology at the
University of Oxford.

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Atypical Trigeminal Neuralgia

Atypical trigeminal neuralgia, also known as Type 2 trigeminal neuralgia, stems from complications with the trigeminal nerve, the main nerve involved in facial and head sensation [1]. This nerve can be subject to impingement, damage, inflammation, or constriction, leading to neuralgia [2, 3].

This condition represents a broader spectrum of facial pain, which can complicate forming a precise clinical picture. It's often diagnosed when patients' symptoms do not fully align with the classical diagnostic criteria for trigeminal neuralgia. This leads to its alternative label, atypical facial pain, indicating that the source may not be exclusively the trigeminal nerve. It is distinct to subtypes of trigeminal neuralgia, such as occipital neuralgia and supraorbital neuralgia

A hallmark of ATN is unilateral burning pain with varying intensity, often accompanied by dysesthesia or paraesthesia—abnormal sensations that can develop over several years [4]. Atypical trigeminal neuralgia also shows a higher prevalence in women and can be exacerbated by stress factors [5].

Did you know?

The trigeminal nerve is the 5th cranial nerve originating in the brainstem and has three branches: the ophthalmic (V1), maxillary (V2), and mandibular (V3), supplying the upper, central and lower parts of your face respectively

Treatments for Atypical Trigeminal Neuralgia

Atypical trigeminal neuralgia can be challenging to manage due to the heterogeneity of the presenting symptoms. Overall, patients with atypical trigeminal neuralgia are more refractory to treatment than typical neuralgia patients.

However, several treatment options have shown benefits for alleviating pain in patients. Clinicians will start atypical neuralgia patients on medication similar to trigeminal neuralgia patients and adjust the dose and treatment according to patient reports.

Managing ATN can be a complex task due to the diverse symptoms it presents. Patients with ATN generally have a more challenging time finding effective treatments compared to those with typical neuralgia.

Nonetheless, a variety of treatments have been beneficial. Clinicians typically begin with medications similar to those used for trigeminal neuralgia and adjust based on the patient's feedback.

Pharmacotherapy, with Carbamazepine as the cornerstone, is frequently the initial approach. It's deemed effective for trigeminal neuralgia and, consequently, for ATN management [6, 7, 8, 9]. For patients unresponsive to Carbamazepine, alternatives like oxcarbazepine, lamotrigine, gabapentin, and baclofen may be pursued [7, 10, 8].

Botulinum toxin A has gained attention for its significant impact on reducing pain. Studies have noted a more than 50% decrease in pain symptoms in ATN patients [11].

When medications fail or are not well-tolerated, surgical options or minimally invasive methods are considered. However, the efficacy of surgical interventions can vary, necessitating thorough evaluations [12].

Procedures like microvascular decompression and radiofrequency thermal rhizotomy, designed to alleviate pressure from trigger points on the trigeminal nerve, may offer pain relief for those unresponsive to medication [7, 13].

Non-drug therapies including exercise are effective at treating trigeminal neuralgia and for pundendal neuralgia, and could be a viable treatment option for atypical trigeminal neuralgia.

The critical factor in treatment selection is personalizing the approach, taking into account the individual's specific symptoms, overall health, and prior treatment responses.

Summary: Atypical Trigeminal Neuralgia

Atypical trigeminal neuralgia, or atypical facial pain, is a challenging diagnosis often given to patients outside the clear-cut boundaries of trigeminal neuralgia. Its broad symptomatology renders treatment complex and varied. Standard treatment protocols mirror those for trigeminal neuralgia but may require more time and patience to achieve effectiveness.

Klara Hatinova

Klara Hatinova

Klara is a postgraduate researcher in experimental psychology at the University of Oxford. She has worked across a spectrum of hot topics in neuroscience, including her current project measuring reinforcement learning strategies in Parkinson’s disease. Previously, she studied the efficacy of psilocybin as a therapy for critical mental health conditions and examined molecular circadian rhythms of migraine disorders. She completed her undergraduate degree in Neuroscience at the University of Glasgow and participated in a year abroad at the University of California, where she worked on a clinical trial for spinal cord injury.