General Information I: Definition, Diagnosis & Differential Diagnosis

Definition

  1. Sudden, severe and recurring (i.e. “paroxymsmal”) facial pain in the trigeminal nerve distribution (the cranial nerve that supplies sensation to the face including the eye).
  2. Trigeminal neuralgia pain is most often described by patients as “sharp”, “intense”, “lancinating”, or “electrical shock-like”.
  3. Trigeminal neuralgia pain is often characterized as one of the most painful conditions known to mankind.

 

Diagnosis

The diagnosis of trigeminal neuralgia is made after assessing the patient’s thorough clinical history.  Typical trigeminal neuralgia pain characteristics include:

  1. Paroxysmal
  2. Intermittent (“on & off”), not constant
  3. “Sharp”, “lancinating”, “electrical shock-like” pain
  4. Each shock lasting a split second to 60-90 seconds

Additional diagnostic considerations:

  1. After a series of repetitive shocks of various duration, often there is a prolonged burning/deep ache lasting minutes to hours.
  2. Pain characteristics may be altered by trigeminal neuralgia medications or prior surgical procedures.
  3. “Triggering factors” are often present, which provoke typical trigeminal neuralgia pain. These include touching the sensitive areas (“triggering zones”), wind blowing on the face, drinking/eating, smiling, brushing teeth, putting on make-up, etc.

 

Differential Diagnosis (“What are other diagnostic possibilities?”):

Glossopharyngeal neuralgia

Geniculate neuralgia

Postherpetic neuralgia

Sphenopalatine neuralgia

TMJ

Cluster headache

Atypical facial pain

Trigeminal neuropathic pain (post-traumatic or idiopathic)

Facial pain of the dental, orbital or nasal sinus origin

(e.g. Root canal, post-surgical, infection, cancer)


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