Constant Face Pain in Typical Trigeminal Neuralgia and Response to Gamma Knife Radiosurgery

Background/Aims: Constant pain, especially if prominent, is sometimes considered incompatible with a diagnosis of typical idiopathic trigeminal neuralgia. This study aims to clarify the frequency of patient-reported constant pain in patients with medically intractable, typical, idiopathic trigeminal neuralgia as diagnosed with standard clinical parameters and confirmed by the response to a modified McGill questionnaire, a ‘hold-still’ test that eliminated triggers and the response to Gamma Knife radiosurgery. Method: Forty consecutive patients with typical trigeminal neuralgia were given questionnaires prior to Gamma Knife radiosurgery. Those with constant pain were further tested by being advised to hold completely still for up to 3 min. Final pain relief was evaluated after Gamma Knife radiosurgery. Results: Twenty of forty patients indicated on a questionnaire that they had constant face pain. Pain decreased on the ‘hold-still’ test on all 12 patients who were tested. Following Gamma Knife radiosurgery, there was no significant difference in pain relief in those without or with constant pain. Conclusion: Patients with typical idiopathic trigeminal neuralgia frequently report that 50% or more of their pain is constant. This constant Received: May 2, 2012 Accepted: September 4, 2012 Published online: January 22, 2013 Ronald Brisman, MD Department of Neurological Surgery, College of Physicians and Surgeons Columbia University, 710 West 168th Street New York, NY 10032 (USA) E-Mail rb36 @ columbia.edu © 2013 S. Karger AG, Basel 1011–6125/13/0912–0122$38.00/0 Accessible online at: www.karger.com/sfn © For permitted use only. ANY FURTHER DISTRIBUTION OF THIS ARTICLE REQUIRES