Just a quick post.
Not that I've read it for a while but the IHS classification for TN can be found at,
Diagnosis would seem quite stringent according to the above, jet reading recent posts we have; vasoglossophyngeal neuralgia, atypical odantalgia, sinus neuralgia thrown into the mix.
If it doesn't fit the IHS classification is it no longer TN and something else? Or an oversight in the classification? I ask the question bearing in mind with a IHS based diagnosis, the cause is unknown, so why would additional symptoms certainly in the trigeminal nerve field change things, ie sinus, now TN no longer a diagnosis? when classification does not allude to a cause.
Trigeminal Neuralgia at base level means pain in the trigeminal nerve distribution. IHS classification if adhered to is lacking.
Recent example, patient complaining of pain back of head and diffuse facial pain: Occipital neuralgia, TN or other?? Separate the symptom pattern we have possible occipital neuralgia and TN both pretty meaningless if taken separately, which many folk do. Both relatively unusual together more so.
Anyhow after a couple of physical therapy treatments later much improved, also his persistent sinusitus since age 14, which for some reason wasn't covered during consult ( we can all improve) but was volunteered.
My point being, had he just mentioned his facial pain to a neuro would he have been diagnosed with TN, and later had he mentioned his additional symptoms would they have been given an additional diagnosis to worry about when all three were connected?
When the diagnostic criteria according to the IHS is such leads to an additional diagnosis for further symptoms and hence know one patient or otherwise knows which direction to head,
Incidently the patient cancelled his private consult, some thirty miles away because he was feeling better.
So is a TN diagnosis, not this example, but past, no longer TN, when treatment of the neck eases symptoms? Is it no longer TN when additional symptoms to the IHS classification rear, when the classification has no concrete causation, just hypothesis.
As an aside I have a new patient coming in four days time, I treat her husband for something and he asked if I might help his wife with neck pain-sure maybe depending. By coincidence during treatment he mentioned his wife has facial pain and has had 2, yes 2 MVD surgeries unsuccessful.. OK he might be confused, but unlikely, now what would be nice is if she was a member of this forum maybe inactive, and treatment of her neck helped her TN. I'll let you know.
Either way IHS classification would seem to be too narrow, or fairly worthless, worse still maybe directing patients to destructive procedures before the conservative. I've yet to make my mind up.