Nerve block for trigeminal neuralgia

[ohiovolffemtp]

Had a teen aged patient come in last night screaming d/t severe right sided facial pain, existing dx of trigeminal neuralgia.  Did a trigeminal nerve block - 1.5" 25 g needle inserted between tragus & condyle of mandible, 6 ml of 80/20 mix of 2% lidocaine & 0.5% marcaine instilled.  Patient reported severe pain during the block.  5 min later pain free.  3rd time I've done it - all 3 times excellent results, way better than my old approach with opiates.

Serial repeat exams: positive cell phone sign, d/c home.

[jmj11]

This is truly odd, a teenager with TN. I worked 38 years in a headache clinic, seeing probably TN patients in the hundreds if not thousands and never remember seeing a teenager. Usually over age 60. If <60 raises concerns about the diagnosis. Yes, TN can occur at almost any age, but it is very rare in these young ages. There are many other facial pain syndromes that mimic TN. So the pain was isolated in the trigeminal nerve and lasting 1-3 seconds, provoked by touching the face, etc? Glad your nerve block worked. 

[ohiovolffemtp]

You raise excellent points.  Patient & mother said dx was confirmed by a neurologist.  Pain had been going on for ~10 hours by the time I saw her.  Patient couldn't identify a triggering factor.  Her reported s/s matched a trigeminal nerve distribution.  Could it have been something else, especially given what you said - certainly.  This is my PRN job, so I doubt I'll see this patient again, but I will see what else I can find out.  Thanks for making me think on this further.