A rare cause of headache; Case report of idiopatic intracranial hypertension concomitant with trigeminal neuralgia

Trigeminal neuralgia (TN) is the condition of sudden, usually unilateral, very short-lasting, stinging, and recurrent pain in the distribution area of one or more branches of the trigeminal nerve. Idiopathic intracranial hypertension (IIH) is an increase in intracranial pressure associated with normal cerebrospinal fluid composition that is not due to a secondary cause. Although not frequent, the association of IIH and TN has also been reported. We aimed to present a rare case report in which TN is concomitant with IIH. A 56-year-old female patient was admitted to our clinic with the complaint of jabbing pain that may feel like an electrical shock on the right side of her face. In the patient's history, she was diagnosed with TN 8 years ago. She had a lightning-flashing pain in the area corresponding to the right mandibular nerve dermatome. Her pain attacks lasted 1-2 min, and recurring 15-20 times during the day. In the CISS sequence cranial MRI, bilateral perioptic CSF distance showed mild prominence, prominence in Meckel caves, and empty sella appearance features. These findings were found to be compatible with intracranial hypertension. As a result,based on these findings, the patient was diagnosed with TN or trigeminal neuropathy accompanying IIH. While patients diagnosed with TN may be associated with IIH, also trigeminal nerve may be affected, although not as much as other cranial nerves in patients with a diagnosis of IIH. The use of cranial MRI may prevent an additional pathology to be missed.