Assessment of hemilateral pain and possible trigeminal neuralgia

Abstract

Objective: To report a case of trigeminal neuralgia observed in a 52-year-old patient who had pre-diabetes and hypertension, fibromyalgia as previous comorbidities, and a surgical history of carpal tunnel syndrome correction. Case details: On September 30, 2022, the patient reported intense right-sided unilateral headache. The patient was on Metformin, Hydrochlorothiazide (HCTZ), and Losartan. For the treatment of possible trigeminal neuralgia, Carbamazepine was initially prescribed at a dose of 200 mg every 12 hours and later adjusted to 200 mg every 8 hours. It was found that the dose of 600 mg per day of Carbamazepine was more effective in relieving the intensity of the pain and improving the patient's mood. Additionally, the patient underwent a magnetic resonance imaging which revealed the presence of vascular branches near the cisternal portion of the bilateral trigeminal nerve, more evident on the right side, without compression. Finally, it is worth noting that adjustments were made to the anti-hypertensive medications. Final Considerations: Trigeminal neuralgia presents a significant pain component for the patient, with a compromise to their quality of life. Therefore, early diagnosis coupled with the introduction of medication in an adjusted dose becomes essential.