Trigeminal neuralgia

International Classification of Headache Disorders (ICHD), 3rd edition​[25]Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211. https://journals.sagepub.com/doi/epub/10.1177/0333102417738202 http://www.ncbi.nlm.nih.gov/pubmed/29368949?tool=bestpractice.com ​​

Recurrent paroxysms of unilateral facial pain in the distribution(s) of one or more divisions of the trigeminal nerve, with no radiation beyond, and fulfilling criteria B and C:

1. Pain has all of the following characteristics:

   1. lasting from a fraction of a second to 2 minutes

   2. severe intensity

   3. electric shock-like, shooting, stabbing, or sharp in quality

2. Precipitated by innocuous stimuli within the affected trigeminal distribution

3. Not better accounted for by another ICHD-3 diagnosis.

The ICHD notes:

• In a few patients, pain may radiate to another division, but it remains within the trigeminal dermatomes.

• Duration can change over time, with paroxysms becoming more prolonged. A minority of patients will report attacks predominantly lasting for >2 minutes.

• Pain may become more severe over time.

• Some attacks may be, or appear to be, spontaneous, but there must be a history or finding of pain provoked by innocuous stimuli to meet this criterion. Ideally, the examining clinician should attempt to confirm the history by replicating the triggering phenomenon. However, this may not always be possible because of the patient’s refusal, awkward anatomical location of the trigger, and/or other factors.