Interdisciplinary approach in ophthalmic trigeminal neuralgia: A case report
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Ada María González-González 1 2 3 , Xabier A Soto-Goñi 4 5 6 * , Fadi Hallal-Peche 6 7 * , Eleuterio A Sánchez-Romero 3 6 8 *
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1 Adavall Physiotherapy and Rehabilitation Clinic S. L., Valladolid, SPAIN2 DENS-ia Research Group, Department of Health Sciences, Miguel de Cervantes European University, Valladolid, SPAIN3 Physiotherapy and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial, Madrid, SPAIN4 Department of Psychobiology, Complutense University of Madrid, Madrid, SPAIN5 Psychology and Orofacial Pain Working Group, Sociedad Española de Disfunción Craneomandibular y Dolor Orofacial, Madrid, SPAIN6 Interdisciplinary Research Group on Musculoskeletal Disorders, Faculty of Medicine, Health and Sports, Villaviciosa de Odón 28670, SPAIN7 Clinical Neurophysiology Department, Central de la Defensa Gómez Ulla Hospital, Madrid, SPAIN8 Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute-Segovia de Arana, Madrid, SPAIN* Corresponding Author

Abstract

Introduction: Trigeminal neuralgia (TN) is a severe pain disorder characterized by electric shock-like cramps and facial pain that is often triggered by innocuous stimuli. TN can be classified as classical, secondary, or idiopathic, with classical TN involving the vascular compression of the trigeminal nerve root. It is more prevalent in women and typically affects the right side of the face.
Case presentation: A 38-year-old woman with persistent right facial pain experienced paroxysms near her right eye leading to headaches. Her medical history included treatment with carbamazepine, amitriptyline, eslicarbamazepine, and sertraline, but symptoms persisted. Diagnostic assessments included physical examinations, laboratory tests, and imaging. Hypersensitivity and allodynia were observed in the trigeminal nerve branches, and a magnetic resonance imaging revealed vascular contact and an arachnoid cyst in 2023.
Results: Despite multiple pharmacological treatments and rehabilitation, the patient’s condition remained chronic with recurrent symptoms. The pharmacological therapies included pregabalin, baclofenac, topiramate, and botulinum toxin. Rehabilitation involved biobehavioral approaches and transcutaneous electrical nerve stimulation therapy. Owing to the persistent symptoms, microvascular decompression (MVD) surgery was advised. Partial improvement was noted in allodynia and sensitivity to rehabilitation; however, paroxysmal symptoms persisted.
Discussion: This case illustrates the importance of a comprehensive multimodal approach to managing TN by integrating pharmacological, rehabilitative, and surgical interventions. The variability in treatment responses poses significant challenges. The literature supports MVD for TN with clear neurovascular compression and highlights the role of rehabilitation as an effective adjunct treatment. Patient experience underscores the potential benefits of rehabilitation and the critical role of imaging in guiding surgical decisions. This approach highlights the necessity for tailored treatment plans in complex TN cases despite challenges in symptom management and treatment adherence.
Conclusions: Rehabilitation, along with pharmaceutical therapy, can be good adjuvant treatment for ophthalmic neuralgia. Regarding the final treatment performed from a medical perspective, MVD is considered the first-line surgical procedure for patients with a clear neurovascular compression etiology determined by imaging.

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Article Type: Case Report

ELECTRON J GEN MED, Volume 22, Issue 2, April 2025, Article No: em640

https://doi.org/10.29333/ejgm/16073

Publication date: 03 Mar 2025

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