Patient Vignette:

We report that case of an 86-year-old female who described 15-years of sharp, stabbing pain that radiated down the distribution of the second and third divisions of her right trigeminal nerve. She described two trigger points, one on her right cheek and a second intra-oral trigger. Her symptoms were often triggered by eating and she had begun to loose weight secondary to pain. She denied having any baseline pain between the episodes of lancinating pain. She denied any contralateral pain, dysasthetic pain or any burning pain sensation. She denied any pain along the first trigeminal division and did not recently undergo any dental work of have a history of dental carries. Her symptoms had been initially well controlled with Carbamazepine 200 mg BID, but had recently worsened despite increasing the dosage to 600 mg BID when she started to develop medication-related side effects. Her past medical history was unremarkable, an on examination she was neurologically intact. Her brain magnetic resonance imaging (MRI) showed no masses or gross abnormalities, and she was diagnosed with trigeminal neuralgia.

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