امرأة عمرها ٥٠ سنة تأتيها منذ شهرين نوبات ألم كالصعقة الكهربائية في خدها وفكها الأيمن تستمر ثواني، عند غسل الوجه أو المضغ أو الريح الباردة، وبين النوبات لا يوجد ألم. الفحص العصبي طبيعي. ما التشخيص الأرجح وعلاجه الأول؟

A 50-year-old woman has had, for two months, electric-shock-like pains in her right cheek and jaw lasting seconds, triggered by washing her face, chewing or cold wind, with no pain between attacks. Neurological exam is normal. What is the likely diagnosis and first treatment?

1. Trigeminal neuralgia, usually carbamazepine
2. Sinusitis, treated with antibiotics
3. Migraine, treated with a triptan
4. Dental pain, treated by immediate extraction

Answer: A) Trigeminal neuralgia, usually carbamazepine. Trigeminal neuralgia causes brief severe shock-like pain triggered by light stimuli. Carbamazepine is first line; triggers are avoided, food is eaten lukewarm and teeth brushed gently.