Trigeminal Neuralgia during Pregnancy

A hyper-estrogenic state characterizes pregnancy. The trigeminal system, abundant in estrogen receptors, becomes particularly susceptible to trigeminal neuralgia – a complication resulting in sudden facial pain perceived as an electric shock. The primary drug for treating trigeminal neuralgia is teratogenic, introducing a significant management dilemma. 

The rare case reports a clinical scenario of pregnancy-induced trigeminal neuralgia that presents as a management challenge.

A 12-week pregnant primigravida presented with symptoms of teeth clenching and severe headache persisting for four hours. The intensity of the pain hindered the patient's ability to eat and engage in conversations, impacting both nutritional intake and mental health.

The lady had normal blood pressure and no urine proteins. Upon investigation, the patient was diagnosed with trigeminal neuralgia. 

Due to the teratogenic nature of carbamazepine, the drug of choice, initiating treatment posed a threat to the fetus. However, alleviating the pain was imperative. 

The patient was initially administered nerve blocks in three divisions of the trigeminal nerve. However, the pain recurred. Hence, radiofrequency ablation was conducted at a later stage of the pregnancy. These interventions effectively limited the pain to a manageable level, allowing the pregnancy to progress until delivery.

This case study emphasizes that although trigeminal neuralgia is a commonly encountered condition, its association with pregnancy is rare, posing a considerable challenge in management. Radiofrequency ablation can be successfully employed as a therapeutic intervention in such cases to alleviate pain and ensure the well-being of both the mother and the developing fetus.

Source: Saravia AC, Gupta S, Tripti K. Indian Journal of Obstetrics and Gynecology Research. 2023 (Ahead of Print).