Treatment of acute exacerbations of trigeminal neuralgia in the emergency department: A retrospective case series

• Type: Article in International Scientific Journal
• Date: 2022

Authors

Pinto, MJ (Author) FMUP; Gomes, A (Author) Other; Pinto, M (Author) Other; Pedro Abreu (Author) FMUP; Costa, A (Author) Other

Journal

Title: Headache

Vol. 62

Pages: 1002-1006

ISSN: 0017-8748

Publisher: Wiley-Blackwell

Indexing

ISI Web of Knowledge - 0 Citations

Scopus - 0 Citations

Other information

Authenticus ID: P-00X-3T0

DOI: 10.1111/head.14373

Abstract (EN): Objective To evaluate the response to treatment of acute trigeminal neuralgia (TN) exacerbations in the emergency department (ED). Background TN is characterized by recurrent and intense pain paroxysms. Some patients experience severe acute exacerbations requiring ED presentation. The optimal management of these episodes is not well established. Methods We present a case series of TN exacerbations in adults who presented to the ED of a tertiary center from January 2008 to December 2020. We analyzed demographic and clinical data, including pharmacological management in the ED. The primary outcome was pain relief, classified into no relief, partial relief, and satisfactory relief based on the qualitative description in the ED's records. Results Ultimately 197 crisis episodes corresponding to 140 patients were included. Most were women (61%, 121/197) with a median age of 63 years (interquartile range: 52-73). Acute TN exacerbations were treated with opioids in 78% (108/139) of crisis episodes, nonsteroidal anti-inflammatory drugs in 42% (58/139), corticosteroids in 21% (29/139), intravenous phenytoin in 18% (25/139), and intravenous lidocaine in 6% (8/139). Of the 108 cases treated with opioids, 78 (72%) required additional drugs for pain management. Intravenous phenytoin allowed satisfactory pain relief in 64% of cases. Conclusion In our sample, opioids were the most used therapeutic approach in acute TN exacerbations despite their low efficacy and subsequent need for further drug treatment in most cases. Most crisis episodes managed with intravenous phenytoin reached total pain relief. Prospective studies are needed to guide the treatment of acute exacerbations of TN.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 5