Trigeminal neuralgia Trigeminal neuralgia (TN) is a painful disorder that is characterized by brief, electric-shock-like pains in the face. It is also known as suicide disease. It is 2 times more common in women than men. TN can first appear at any age, but disease onset occurs after the age of 40 years in more than 90% of cases, and the peak age of onset is between the ages of 50 and 60 years. Pain of trigeminal neuralgia is Electric-shock-like, shooting, stabbing, or sharp in quality. It is usually moderate to severe. Each attack of pain lasts between a few seconds and 2 minutes but can rapidly be followed by another attack. Between 10 and 70 attacks can occur in a day. There is often a refractory period between attacks. With disease progression, attacks tend to get longer. Spontaneous remission periods can occur, which initially can last for months or years, but over time the remission periods become shorter. In the condition termed “TN with concomitant persistent facial pain, ” a prolonged period of burning and aching of lower intensity follows the sharp shooting pain and can last for hours. Light innocuous stimuli like combing hair, washing face, light breeze etc. to the affected side of the face provoke pain. Anxiety and depression, as well as deterioration of quality of life, are common consequences of the disease and resolve if there is no pain. Patients live in fear of worsening pain attacks, lack of confidence in dealing with pain attacks and feel isolated due to decreased social activities and lack of contact with other sufferers. Investigations Magnetic resonance imaging (MRI) is useful imaging technique to determine the presence of lesions, such as cysts or tumors, vascular malformations, plaques of multiple sclerosis, as well as vascular compression of the trigeminal nerve. In most cases, no structural cause is found. Treatment Medications like carbamazepine, oxcarbamazepine, lamotrigine, baclofen, gabapentin, pregabalin form the mainstay of treatment of trigeminal neuralgia. But as the disease progresses, the pain becomes less responsive to these medications. This warrants the advanced pain management treatment like radiofrequency ablation (RF) of gasserian ganglion, pulsed radiofrequency (PRF) of mandibular, maxillary or ophthalmic nerve. It has been observed that along with neuropathic pain, the patients of TN have significant myofascial pain. Ultrasound guided dry needling forms the mainstay of treatment in such cases along with RF or PRF.