Headache and Pain Research

Review Articles

Trigeminal Neuralgia: Pathophysiology, Clinical Features, and Therapeutic Management: Ekene Nnagha, Chidubem Adi, Daniel Akpan; Received January 27, 2026 Accepted March 17, 2026 Published online June 4, 2026; DOI: https://doi.org/10.62087/hpr.2026.0005 [Epub ahead of print]

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Abstract PDF: Trigeminal neuralgia (TN) is a severe, disabling neuropathic facial pain disorder classified among cranial neuralgias within headache medicine. Despite well-established diagnostic criteria, TN remains frequently misdiagnosed, particularly in dental and primary care settings. This review provides a clinically focused overview of the epidemiology, pathophysiology, classification, diagnostic approach, and contemporary management of TN, with relevance to headache and pain research and clinical practice. Neurovascular compression with focal demyelination at the trigeminal nerve root entry zone is considered the predominant mechanism in classical TN. Diagnosis is primarily clinical and guided by International Classification of Headache Disorders, 3rd edition criteria, with magnetic resonance imaging essential for excluding secondary and idiopathic causes. Carbamazepine and oxcarbazepine remain first-line therapies, whereas microvascular decompression and minimally invasive neurosurgical procedures provide effective options for medically refractory disease. TN requires accurate diagnosis and individualized management. Advances in pharmacological and interventional treatments have improved outcomes and underscore the importance of multidisciplinary care within headache and pain medicine.

Efficacy and Safety of Repetitive Transcranial Magnetic Stimulation in Postherpetic Neuralgia: A Systematic Review and Meta-Analysis: Abdallah Abbas, Basant Lashin, Mohamed Abouzid, Hadir Mustafa Mohamed, Mohamed El-Moslemani, Mohamed A. Zanaty, Haneen Sabet, Dina Essam Abo-elnour, Ahmed Ibrahim Ghonimy Shedid, Mohamed Salah Mohamed Syed, Amna Hussein, Hoda Awad, Ahmed M. Raslan; Headache Pain Res. 2025;26(2):91-105. Published online April 16, 2025; DOI: https://doi.org/10.62087/hpr.2024.0032

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Abstract PDF Supplementary Material: This study evaluated the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) for pain management in postherpetic neuralgia (PHN). A comprehensive literature search was conducted through May 2024 in Scopus, PubMed, Web of Science, and Cochrane Library. Eligible studies included clinical trials, observational, and case-control studies. Two reviewers independently screened studies and extracted data. Risk of bias was assessed using RoB 2 for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. Meta-analysis was performed using Review Manager v.5.3, with heterogeneity evaluated by chi-square and I² tests. Five studies (245 patients) were included, with rTMS sessions ranging from 10 to 28. Meta-analysis showed significant pain reduction with rTMS compared to sham treatment. At 2 weeks post-treatment, the mean pain score difference (visual analogue scale) was –1.44 (95% CI: –2.12 to –0.77; p<0.0001), with sustained relief at 1 and 3 months. However, no significant differences were found in the patient’s global impression of change scale, sleep quality, quality of life (QoL), medication regulation, or adverse events. rTMS exerted a consistent pain relief effect of rTMS, but its impact on broader aspects of patient well-being was less clear. rTMS provides sustained pain relief in PHN for up to 3 months, but its impact on QoL and secondary outcomes remains unclear, warranting further investigation.

Case Report

Three Cases of Secondary Trigeminal Neuralgia Caused by Maxillary Sinus Cyst: Eungue Lee, Wonseok Jeon, Joongwon Park, Junho Choi, Jong-Hee Sohn, Ho Jun Lee, Sang-Hwa Lee; Korean J Headache. 2023;24(1):28-31. Published online June 30, 2023

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Abstract PDF: Trigeminal neuralgia is a neuropathic pain disorder characterized by elicited paroxysms of stabbing pain in a specific region. Trigeminal neuralgia is classified into three types: classical, secondary, and idiopathic. The classic type, which is the most common, is caused by vascular compression of the trigeminal nerve root. Carbamazepine and oxcarbazepine are the first-line treatment choice for trigeminal neuralgia and offer meaningful pain control in almost 90% of patients. However, if there is no response to medical treatment, secondary trigeminal neuralgia should be considered. Secondary trigeminal neuralgia is attributed to an identifiable neurologic disease. Additionally, there are various secondary causes such as skull base fractures and paranasal sinus lesion. Two cases of secondary trigeminal neuralgia caused by maxillary sinus cyst were previously reported in South Korea. We experienced 3 cases of secondary trigeminal neuralgia induced by maxillary sinus cyst, which exhibited different clinical and radiological findings compared to the previous cases.

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