Trigeminal neuralgia is associated with increased risk of cerebrovascular disease, myocardial infarction and suicide – a nationwide Swedish study

Trigeminal neuralgia is sometimes referred to as the suicide disease, but long-term occurrence of comorbidities and mortality are not well known. The aim of the present study was to investigate whether patients diagnosed with trigeminal neuralgia have an increased risk of morbidity and mortality compared to the general population. A nationwide, retrospective cohort study was conducted using Swedish national health and death registers. Adults diagnosed with trigeminal neuralgia between 2001 and 2005 were included. Comorbidities were identified from the time of diagnosis and onwards. Standardised incidence ratios (SIR) and standardised mortality ratios (SMR) were calculated. The cohort comprised 3531 patients with a median follow-up time of more than 17 years. SIR was significantly elevated for cerebrovascular disease (SIR 1.4–1.8), acute myocardial infarction (SIR 1.3), external causes of injury (SIR 1.5) and intentional self-harm (SIR 2.1). Male patients had a higher risk of myocardial infarction and ischemic stroke, while women had an increased risk of intentional self-harm and unintentional poisoning. No increase was seen for overall mortality, but suicide risk was more than doubled among women (SMR 2.5). This study highlights the severe impact of trigeminal neuralgia on patients’ lives, supporting the characterisation of trigeminal neuralgia as a true suicide disease. Further studies are warranted to examine causality and to analyse the effects of early treatment, especially surgical intervention.