<unk>  <unk>  is a neuropathic disorder of the<unk>  nerve that causes episodes of intense pain in the eyes, lips, nose, scalp, forehead, and jaw.It is also known as Tic Douloureux or Fothergill's disease (named after John Fothergill).<unk>  nerve is one of the largest and widely distributed cranial nerve with three branches ophthalmic nerve (V1), maxillary nerve (V2) and mandibular nerve (V3). Ophthalmic and maxillary are purely sensory, while mandibular nerve has both sensory and motor functions. Pain of<unk>  affects sensory distributions and typically radiates to maxillary and mandibular divisions in 35% of affected individuals. International Association of Study of Pain (IASP) defined<unk>  as "sudden usually unilateral severe brief stabbing recurrent pain in the distribution of one or more branches of 5th cranial nerve". Similarly, International Headache society (IHS) defined it as "painful unilateral affliction of face characterized by brief electric shock like pain limited to the distribution of one or more divisions of<unk>  nerve".<unk>  is usually characterized by paroxysmic episodes of sudden, severe, shock like pain that lasts for seconds to a few minutes. It is almost always unilateral, but is bilateral in rare cases, and right side is affected more often than the left side. These episodes can occur spontaneously or can be triggered by a mild cutaneous stimuli like chewing, shaving, touching, brushing teeth or even air currents can trigger an episode. The pain tends to occur in cycles with remissions lasting months or even years. These episodic attacks are known to worsen in frequency or severity overtime and can have a significant impact on a person's quality of life, resulting in problems such as weightloss, depression and, in severe cases, suicide. Attacks may provoke patients to grimace, wince or make an aversive head movement, known as tic, hence the term 'tic douloureux". Data is not consistent, but some studies have shown that migraine and hypertension can act as a risk factor for<unk> . According to etiology, IHS has classified<unk>  into three main categories classical, secondary and idiopathic<unk> . Although majority of the cases of<unk>  are idiopathic but other causes may include systemic diseases like multiple sclerosis, diabetes mellitus, infectious conditions caused by Mycobacterium leprae, Secondary syphilis, Leptospirosis etc, injuries to<unk>  nerve both centrally and peripherally caused by trauma, ENT pathologies, intracranial tumors, cysts, arteriovenous malformations, tuberculomas and allergic reactions. Pathology of<unk>  is related to demyelination and dystrophy of nerve caused by above mentioned etiological factors. Allergic reaction and its frequent manifestations such as cold, chronic rhinitis, maxillary sinusitis, tonsillitis and chronic inflammation can trigger immune response which in turn results in accumulation of immunoglobulins and histamine in<unk>  nerve region and play role in<unk>  pathogenesis. Diagnosis of<unk>  is mainly clinical, based primarily on history, physical examination and neurological examination, but other causes of facial pain should be ruled out. Common differentials include glossopharyngeal neuralgia, cracked tooth syndrome, cluster headaches and postherpetic neuralgia. Treatment of<unk>  depends upon severity and underlying cause of disease and include medicines mainly anti epileptics, surgery and complimentary approaches. Carbamazepine is the first line drug used for initial management. However, as it is a long term condition, some people overtime may stop responding to medications, or they may experience unpleasant side effects. For those people surgical options can be considered. Psychosocial support also plays an important role in improving quality of life.
Trigeminal neuralgia
Thunderclap headache
Rebound headache
Glossopharyngeal neuralgia
Tension headache
Morning headache
Cluster headache
Migraine