Trigeminal Neuralgia: Factors Affecting Early Pharmacotherapeutic Outcome

Objectives: A cohort study to examine demographic and clinical features which are associated with the pharmacotherapeutic outcome in CTN patients.

Methods: Patients with a clinical profile indicating a diagnosis of Classical Trigeminal Neuralgia (CTN), were enrolled prospectively. Demographic and pain related characteristics were collected. All patients were then initiated on a standardized and accepted stepped pharmacotherapeutic protocol for the management of CTN. Initial pain scores and prospectively collected pain scores from pain diaries were used to assess the treatment outcome, with a ≥50% reduction considered significant.

Results: The study cohort therefore consisted of 81 patients and based on attack duration these were divided into short (≤ 2 minutes, n=61) and long (> 2 minutes, n=20) groups, for further analysis. The group with short attack duration is most probably CTN while the long attack group is probably made up mostly of patients with shortlasting unilateral neuralgiform headache attacks with autonomic signs (SUNA). Employing an accepted stepped phamacotherapeutic protocol for the management of CTN, significant improvement was more frequent in the short (74%) than in the long attack group (50%, p=0.05). In the short attack group there were significant associations between a significantly poor treatment response and longer disease duration, the presence of autonomic signs and atypical pain descriptors for pain quality (p<0.05).

Conclusions: This report supports previous findings that prolonged disease duration and autonomic signs are negative prognostic indicators. The differential response of patients with longer attack duration, who may be suffering from SUNA, suggests that for CTN patients with atypical signs, resistant to standard anticonvulsants.