Clinical Statistics of Trigeminal Neuralgia （Classical Trigeminal Neuralgia and Painful Trigeminal Neuropathy） based on the International Classification of Headache Disorders 3rd Edition （Beta Version）

Abstract

Purpose: In the international classification of headache disorders 3rd edition （ICHD-3β）, trigeminal neuralgia （13.1） is classified into 2 categories; classical trigeminal neuralgia （13.1.1） and painful trigeminal neuropathy （13.1.2） （previously referred to as symptomatic trigeminal neuralgia）. We aimed to clarify features of trigeminal neuralgias by investigating clinical statistics of patients at orofacial pain clinics.
Methods: The clinical data of 69 patients with trigeminal neuralgia who visited the orofacial pain clinic of dentistry and oral surgery at Keio University Hospital, Kawasaki Municipal Ida Hospital and Hino Municipal Hospital between April 2014 - April 2017 were analyzed retrospectively. The ratio of each pathological diagnosis and therapeutic responses of treatment were evaluated.
Results: Painful post-traumatic trigeminal neuropathy （13.1.2.3）, a subclass of a painful trigeminal neuropathy was most commonly observed （51％）. Classical trigeminal neuralgia, purely paroxysmal （13.1.1.1） was 28％, and classical trigeminal neuralgia with concomitant persistent facial pain （13.1.1.2） was 6％. Tooth extraction at 66％ was the most common cause of painful post-traumatic neuropathy. As treatment, pregabalin was prescribed for painful post-traumatic trigeminal neuropathy with improvement of pain in 51％ of patients. Carbamazepine was prescribed in patients with classical trigeminal neuralgia. The treatment was effective in 63％ of patients of pure paroxysmal type and 25％ of patients with persistent facial pain type.
Conclusions: It was clarified some differences in some features of progress and efficacy of pharmacotherapy for each subtype of trigeminal neuralgia （in Orofacial pain outpatient clinic）.