Impact of climatic factors on trigeminal neuralgia and facial neuropathy in primary care during a fourteen-year time-series study

Trigeminal neuralgia and related facial neuropathic pain are severe disorders that are characterized by paroxysmal facial pain. Although meteorological factors have been associated with migraine and musculoskeletal pain, their role in trigeminal neuropathic pain remains poorly understood. Biometeorological mechanisms suggest that climatic variables may modulate symptom perception and healthcare-seeking behavior rather than disease incidence. The aim of this study was to evaluate the association between climatic variables and risk of seeking primary care for trigeminal neuralgia and facial neuropathy over a 14-year period in a Mediterranean population. This retrospective cohort study was conducted using electronic health records from three primary care centers in Madrid (Spain) between 2010 and 2023. All consultations coded as trigeminal neuralgia (ICPC-2 N03) or facial neuropathy (ICPC-2 N89.02) were included in the study. Individual consultation events were linked to meteorological data from the Spanish State Meteorological Agency. A piecewise additive exponential event-based model fitted with a negative binomial distribution was applied to estimate hazard ratios (HR), allowing flexible modeling of non-linear climatic effects and long-term temporal trends in a low-event-density, time-to-event context. A total of 246 consultations were identified (mean age 66.6 ± 14.6 years; 66.7% female). Increased hours of sunshine were independently associated with a higher risk of seeking medical attention for trigeminal neuralgia (HR = 1.081 per additional hour; 95% CI, 1.016–1.150). A significant non-linear association with ambient temperature was observed, with higher consultation risk at temperatures below approximately 10 °C and stabilization thereafter. The long-term temporal trend remains largely stable until there is a significant increase in consultation risk during the post-COVID-19 period (2021–2023). In this population-based primary care study, specific climatic factors, particularly sunlight exposure and low ambient temperature, were associated with the risk of seeking medical attention for trigeminal neuralgia and facial neuropathic pain. These findings suggest that climatic variables may act as modulators of healthcare utilization rather than primary drivers of disease incidence. Intrinsic neuropathological mechanisms remain central to trigeminal neuralgia pathophysiology, whereas environmental factors may influence symptom perception and care-seeking behavior in susceptible individuals.