Diagnostic and Therapeutic Errors in Classical Trigeminal Neuralgia: a Multicenter Survey

Abstract Background Classical Trigeminal neuralgia (CTN) is a severe, disabling form of painful cranial neuropathy. Even though CTN has a typical clinical picture, diagnosis it is often missed or delayed in clinical practice. This study was carried over to investigate the occurrence of diagnostic and therapeutic errors in CNT. Methods We studied 102 patients suffering from CTN recruited through a multicentric survey. All the patients were evaluated using telephone/frontal interviews conducted by headache/pain specialists using an ad hoc questionnaire. Results Patients were mostly females (F:M ratio 2.64:1); in 50% of cases age ranged between 51 and 70 years. Eighty-six percent of the patients consulted a physician at the time they experienced the first pain attacks. Specialists consulted before CTN diagnosis was finally made were: primary care physicians (43.1%), dentists (in 30.4% of cases), otorhinolaryngologists (3.9%), neurosurgeons (3.9%), neurologists or headache specialists (14.7%), others (8%). In most cases (85.3%) the final diagnosis was made by a neurologist or headache specialist, and the mean interval between the disease onset and the specialist consultation was 10.8±21.2 months. The correct diagnosis were made after 7.2±12.5 months, being the misdiagnoses at the first consultation in 42.1% of cases. Ten patients underwent erroneous dental extraction. Instrumental and laboratory investigations were carried out in 93.1% of the patients before the final diagnosis of CTN. Conclusions Our results emphasize the need to improve the neurological knowledge in order to promptly recognize the clinical picture of CTN and properly adhere to the specific treatment guidelines.