Background & Aims
Trigeminal neuralgia (TN), primarily affecting the maxillary and mandibular branches, manifests as sudden and severe facial pain without autonomic symptoms such as tearing and ptosis. However, rare cases present with such symptoms, which necessitates differentiation from short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)/short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA), as these disorders share similar pain episodes within the trigeminal sensory territory, often including autonomic manifestations. This study aims to clarify distinguishing features and facilitate accurate diagnosis.
Methods
We report a 63-year-old woman presenting with left upper premolar area pain upon infraorbital, zygoma, and upper lip contact. Her pain history followed re-endodontic and prosthodontic treatment of the left upper second premolar, and examination showed electric-like sensations without spontaneous pain. Treatments included anti-inflammatory medications and occlusal adjustments, which proved ineffective. A tentative diagnosis of TN led to treatment with carbamazepine, oxcarbazepine, and baclofen, noting episodic conjunctival injection and asymmetric tongue sensations during severe attacks.
Results
Differential diagnoses between SUNCT/SUNA and TN include pain location, duration, and the presence of autonomic symptoms. SUNCT/SUNA commonly affect the V1 region with possible extension beyond the trigeminal area, with longer-lasting pain episodes. TN, commonly located in V2/V3, is induced by stimuli, refractory, and presents with severe pain. SUNCT/SUNA display prominent autonomic symptoms and respond variably to lamotrigine, gabapentin, and topiramate, while TN shows a marked response to carbamazepine, effective in 80% of cases.
Conclusions
This case, marked by touch-evoked, short-duration pain in the maxillary branch and late-emerging mild autonomic symptoms, responded well to carbamazepine, favoring a TN diagnosis over SUNCT/SUNA. The presence of autonomic symptoms in suspected TN cases necessitates careful reevaluation to distinguish from SUNCT/SUNA, particularly when carbamazepine response is suboptimal. Accurate differentiation is crucial for targeted therapy, as medication efficacy varies significantly between these conditions.
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Presenting Author
Younjung Park
Poster Authors
Topics
- Specific Pain Conditions/Pain in Specific Populations: Orofacial Pain