Trigeminal neuralgia during sleep.

Pain paroxysms in trigeminal neuralgia (TN) are sudden and extremely intense. Nonetheless, many clinicians who treat TN report that patients are rarely if ever awakened at night by pain attacks. If true, this observation is important as it implies the presence of a powerful sleep protective mechanism. We queried TN patients and their habitual sleep partners about painful awakenings and discovered that such awakenings are in fact quite common. As during the day, pain paroxysms during sleep are typically induced by natural stimuli at TN trigger points. Brief attacks sometimes occur without frankly awakening the patient, but they appear nonetheless to be painful.