A Study on the Association Between Refractory Trigeminal Neuralgia and Hypertension in a Nigerian Tertiary Hospital.

Abstract

Background: Poorly controlled hypertension can result in the refractory pain of trigeminal neuralgia (TN).

Objective: To determine the association between refractory TN and hypertension among patients seen at the Oral Medicine Clinic, University of Benin Teaching Hospital.

Methods: A 1-year prospective study in which patients diagnosed with refractory TN with poorly controlled blood pressure (BP) were managed with the cardiologist and followed up for 4 weeks, to determine the effect of BP control on the pain of TN. On each review, patient’s BP was documented, along with their pain scores using the Numerical rating scale (NRS). These assessments were done at a 2-week and 4-week intervals following therapeutic intervention for the BP, and the values compared.

Results: Of the 25 cases of TN seen during the study period, 12 were diagnosed with refractory TN secondary to uncontrolled hypertension. The cases consisted of 6 (50%) males and 6 (50%) females. The mean age of the patients was 54 ± 9.1years. The refractory pain was commoner on the left side (n=7, 58.3%) of the face; right side (n=5, 41.7%), with the mandibular division of the trigeminal nerve (n=9, 75%) more affected than the maxillary division (n=3, 25%). Upon institution of appropriate BP control, there was reduction in the BP. The median systolic BP dropped from was 161.5mmHg (16.75) to 136.0mmHg (20.5); the median diastolic BP dropped from 100.0mmHg (13.5) to 81.5mmHg (3.75). There was also a significant reduction in the NRS-scores from 8 (2.0) to 3.5 (1.75).

Conclusion: In conclusion hypertension should be taken into consideration as a triggering factor for TN, and also in the development of refractory pain in patients with TN associated with hypertension. As a result, regular blood pressure check and control is necessary for TN cases associated with hypertension