Handbook of Pain Syndromes: Biopsychosocial Perspectives

By Andrew R. Block; Edwin F. Kremer et al. | Go to book overview

Chapter 20
Trigeminal Neuralgia

Eli Eliav
Department of Oral Medicine, Oral Diagnosis
and Oral Radiology, and Department of Anatomy,
Hadassah School of Dental Medicine, The Hebrew University, Jerusalem

Richard H. Gracely
Pain and Neurosensory Mechanisms Branch
NIDR, National Institutes of Health

Trigeminal neuralgia (TN) is a distinct syndrome characterized by paroxysms of brief stabbing pain in the face, often near the mouth. The single episodes or clusters of episodes may be followed by long pain-free intervals. The pain is described as mild to extremely intense with an incisive, stabbing or jabbing quality ( Fields, 1996; Stookey & Ransohoff, 1959). The pain is often accompanied by a characteristic unilateral, intense grimacelike motor response.


HISTORICAL BACKGROUND

Descriptions of TN can be traced to the first century A.D., in which Aretaeus described the combination of intense episodic pain and facial spasm of what he termed heterocrania ( Stookey & Ransohoff, 1959). These same features were reported by the philosopher and physician John Locke following treatment of the wife of the English Ambassador during a visit to Paris in 1677. His careful description is a classic that clearly withstands the test of time ( Stookey & Ransohoff, 1959). However, it was not until 1756 that the French physician Nicolaus André recognized the unique nature of the entity and proposed the term ticdouloureux that captured both the pain and convulsive features of the paroxysmal attack. Independently, John Fothergill in 1773 described a series of 14 cases characterized by the dual features of pain and muscular contraction, with pain the primary compo-

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