OCTOBER 7TH was the sixth annual international trigeminal neuralgia awareness day! So…. I wanted to see if there were any new guidelines that health care professionals are following to help diagnose and treat patients suffering from TN (trigeminal neuralgia). Back in 2008, the American Academy of Neurology and the European Federation of Neurological Societies launched a joint Task Force to prepare general guidelines for the management of TN. Naturally, I wanted to see if there is anything more current, and I came across the 2019 publication by Lars Bendtsen, MD, Ph.D., Dr.Med.Sci and the European Academy of Neurology. The link to access on the web is here: European Academy of Neurology guideline on trigeminal neuralgia 2019.
Trigeminal neuralgia is an extremely painful condition which can be diﬃcult to diagnose and treat. In Europe and America, many different specialties manage the treatment of TN patients. Therefore, there is a great need for comprehensive guidelines for the management of TN. The European Academy of Neurology asked an expert panel to develop recommendations for a series of questions that are essential for the daily clinical management of patients with TN.
In an attempt to settle the confusion on terminology and the diﬀerent settings between the International Association for the Study of Pain and the International Headache Society, a new classification laid out three causative categories:
- Idiopathic TN – no neurovascular contact (NVC) or NVC without morphological changes of the trigeminal root
- Classical TN – due to a neurovascular compression with morphological changes of the trigeminal root
- Secondary TN – due to major neurological diseases such as cerebellopontine angle tumors or multiple sclerosis
Also, two smaller categories were classified:
- Purely paroxysmal (sudden increase or recurrence of symptoms) TN (with paroxysmal pain only)
- TN coupled with continuous pain.
This classification and the terminology have been shared by the latest edition of the International Classification of Headache Disorders and by the World Health Organization International Classification of Disease.
Valuable new knowledge has emerged regarding diagnosis, clinical characteristics and imaging, and new drugs to assess and manage trigeminal neuralgia. Unfortunately, not much is mentioned about the potential benefits of trying a course of physical therapy by a skilled physical therapist that specializes in the evaluation and treatment of Temporomandibular Disorders and Orofacial Pain. Please see my past blog on trigeminal neuralgia and the potential benefits of physical therapy: TRIGEMINAL NEURALGIA PHYSICAL THERAPY TREATMENT APPROACH
I wish all those suffering from Trigeminal Neuralgia the support they need to thrive despite the challenges this condition presents.