Figure 1: Extra Oral   

Figure 2: Extra Oral

Figure 3: OPG

Figure 4, 5: A small branch of vertebral artery seen intending and looping over the root exit zone of cisternal segment of right trigeminal nerve

Related to systemic Diseases
Injury to Trigeminal nerve Directly
Idiopathic Causes
Peripheral Nerve
Central Nerve
Multiple Sclerosis vascular diseases, rheumatism etc.,
“Allergic Hypothesis” infection, ENT pathology etc.,
“Neurovascular compression Hypothesis” arteriovenous malformation, malformation, meningiomas. Schwannomid cyst, aneurysms, terbeculomas etc.,
Conditions that evoke dystropy and demyelination
“Compression syndrome hypothesis” due to narrowing of the canal, trauma etc
Table 1: Showing side effects of Metronidazole
Character: Shooting,sharp Terrifying,exhausting  Unbearable
Provoking: Light touch (eating, talking) Spontaneous
Severity : Moderate  Severe
Relieving : Sometimes sleep  Drugs
Trigeminal nerve: Right (60%)  Rarely 1st division
Associated: Trigger points  Sensory change
Site: Unilateral
Timing: Periods of remission Periods of exacerbation
Table 2: classical clinical features of trigeminal neuralgia
  1. Paroxysmal attacks of facial pain which last a few seconds to less than two minutes.
  2. Pain has at least 4 of the following characteristics:
    • Distribution along one or more divisions of the trigeminal nerve.
    • Sudden, intense, sharp, superficial, stabbing or burning in quality.
    • Pain intensity is severe.
    • Precipitation from trigger areas, or by certain activities such as eating, talking, washing the teeth or cleaning the face.
    • Between paroxysms the patient is entirely asymptomatic.
  3. Attacks are stereotyped in the individual patient.
  4. No neurological deficit and exclusion of other causes.
Table 3: The diagnostic criteria of the International Headache Society (IHS) (1988) [3]