Trigeminal neuralgia is a common cause of facial pain, typically producing paroxysmal bursts of shooting pain in one or more divisions of the trigeminal nerve. Whilst it usually occurs as a primary phenomenon due to neurovascular conflict, secondary causes account for around 15% of cases, most commonly cerebellopontine angle tumours. Multiple sclerosis is another common secondary cause of presumed inflammatory aetiology.

We report a case of trigeminal neuralgia in association with diffuse scleroderma. A 43 year old carpenter presented with typical symptoms of unilateral facial pain around a year after receiving a diagnosis of systemic sclerosis with seropositivity to Scl-70 and centromere antibodies. MR imaging at the time revealed enhancement of the left trigeminal nerve, which resolved on subsequent imaging six months later.

The association of trigeminal neuralgia and diffuse scleroderma has previously been reported, with a recent case-control study providing novel evidence of a direct association between the two conditions. Nevertheless it represents a very rare cause in patients presenting to the neurology clinic. In this presen- tation we explore the subject of secondary trigeminal neuralgia and provide a précis of the up-to-date management for this painful condition.