pISSN 2005-9159
eISSN 2093-0569

Clinical Research Article

Korean J Pain 2021; 34(1): 66-71

Published online January 1, 2021 https://doi.org/10.3344/kjp.2021.34.1.66

Copyright © The Korean Pain Society.

Atypical triggers in trigeminal neuralgia: the role of A-delta sensory afferents in food and weather triggers

Wenjun Koh , Huili Lim , Xuanxuan Chen

Department of Anaesthesiology, Singapore General Hospital, Singapore

Correspondence to:Wenjun Koh
Department of Anaesthesiology, Singapore General Hospital, Outram Road, 169608, Singapore
Tel: +65-6222-3322
Fax: +65-6224-9221
E-mail: kohwenjun@u.nus.edu

Handling Editor: Young-Bok Lee

Received: July 14, 2020; Revised: September 10, 2020; Accepted: September 11, 2020


Background: Trigeminal neuralgia is a debilitating craniofacial pain syndrome that is characterized by paroxysms of intense, short-lived electric shock-like pains in the trigeminal nerve distribution. Recently, the presence of triggers has become one of the key diagnostic criteria in the 3rd edition of the International Classification of Headache Disorders. Light touch is the most common trigger, however other non-mechanical triggers, such as cold weather and certain foods, have been thought to provoke trigeminal neuralgia anecdotally. We aimed to characterize the prevalence and characteristics of these atypical triggers.
Methods: We conducted a retrospective, cross-sectional study of atypical triggers in trigeminal neuralgia patients seen in a tertiary pain clinic in Singapore. Patients were recruited via clinic records, and study data were identified from physician documentation.
Results: A total of 60 patients met the inclusion criteria. Weather triggers were observed in 12 patients (20%), of which five patients (8%) reported strong winds, 4 patients (7%) reported cold temperatures, and 3 patients (5%) reported cold winds as triggers. Fifteen patients (25%) had a specific food trigger, of which 10 patients (17%) reported hard or tough food, 5 patients (8%) reported hot/cold food, 4 patients (7%) reported spicy food, and 2 patients (3%) reported sweet food as triggers.
Conclusions: Although trigeminal neuralgia is most commonly triggered by mechanical stimuli, atypical triggers such as cold temperatures and certain foods are seen in a significant proportion of patients. These atypical triggers may share a common pathway of sensory afferent Aδ fiber activation.

Keywords: Cold Temperature, Facial Neuralgia, Food, Nerve Fibers, Pain, Precipitating Factors, Prevalence, Trigeminal Neuralgia, TRPV Cation Channels, Wind.