There is a limited understanding of risk factors and comorbidities in trigeminal neuralgia, a disease characterized by paroxysms of severe unilateral facial pain and a higher incidence in women. We aim to identify temporally associated comorbidities involving trigeminal neuralgia by analyzing nationwide disease trajectories. Using data from 7.2 million unique individuals in the Danish National Patient Register between 1994 and 2018, each individual diagnosed with trigeminal neuralgia was compared with 10,000 matched controls to identify co-occurring diseases. The sequential disease associations were identified in sex-stratified disease trajectories. A Cox-regression analysis investigated whether treatment with carbamazepine or oxcarbazepine, as compared with gabapentin, pregabalin, or lamotrigine, was associated with stroke risk. Finally, we investigated the stroke polygenic risk score and its association with stroke incidence in a subset of genotyped individuals with trigeminal neuralgia. We included 7141 individuals with trigeminal neuralgia (64.2% female, mean age at diagnosis 58.7 years) and identified 18 diseases associated with subsequent trigeminal neuralgia. After diagnosis, trigeminal neuralgia was associated with 9 diseases, including ischemic stroke (relative risk 1.55). Carbamazepine or oxcarbazepine treatment increased the ischemic stroke risk (hazard ratio 1.78; 95% confidence interval 1.47-2.17); however, the polygenic risk of stroke showed no association. In the Danish population, a trigeminal neuralgia diagnosis is temporally associated with 27 diseases revealed in systematic disease trajectories. Trigeminal neuralgia itself and its first-line treatment, but not a stroke polygenic risk score, was associated with an increased risk of ischemic stroke indicating that vascular risk factors should be routinely assessed in individuals with trigeminal neuralgia.

中文翻译：

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三叉神经痛及其合并症：一项全国性的疾病轨迹研究。


对三叉神经痛的危险因素和合并症的了解有限，三叉神经痛是一种以阵发性严重单侧面痛为特征的疾病，女性发病率较高。我们的目标是通过分析全国疾病轨迹来确定涉及三叉神经痛的时间相关合并症。使用 1994 年至 2018 年间丹麦国家患者登记册中 720 万个独特个体的数据，将每个被诊断患有三叉神经痛的个体与 10,000 个匹配的对照进行比较，以确定同时发生的疾病。在性别分层的疾病轨迹中确定了连续的疾病关联。Cox 回归分析调查了与加巴喷丁、普瑞巴林或拉莫三嗪相比，卡马西平或奥卡西平治疗是否与卒中风险相关。最后，我们调查了三叉神经痛基因基因个体子集的卒中多基因风险评分及其与卒中发病率的相关性。我们纳入了 7141 名三叉神经痛患者 （64.2% 为女性，诊断时平均年龄 58.7 岁），并确定了 18 种与后续三叉神经痛相关的疾病。诊断后，三叉神经痛与 9 种疾病相关，包括缺血性卒中 （相对危险度 1.55）。卡马西平或奥卡西平治疗增加了缺血性卒中风险 （风险比 1.78;95% 置信区间 1.47-2.17）;然而，中风的多基因风险没有显示关联。在丹麦人群中，三叉神经痛的诊断与系统性疾病轨迹中揭示的 27 种疾病暂时相关。 三叉神经痛本身及其一线治疗，而不是卒中多基因风险评分，与缺血性卒中风险增加相关，表明三叉神经痛个体应常规评估血管危险因素。