Summary
Definition
History and exam
Key diagnostic factors
- facial pain
- presence of risk factors
Other diagnostic factors
- prior oropharyngeal or facial trauma
- prior herpetic outbreak
- sensory/motor changes
Risk factors
- increased age
- multiple sclerosis
- female
- hypertension
Diagnostic investigations
1st investigations to order
- no first test
Investigations to consider
- intra-oral x-ray
- MRI
- trigeminal reflex testing
Treatment algorithm
newly-diagnosed trigeminal neuralgia (TN)
anticonvulsant-unresponsive trigeminal neuralgia (TN)
medicine-unresponsive trigeminal neuralgia type I (TNI)
medicine-unresponsive trigeminal neuralgia type I/II (TNI/II)
refractory trigeminal neuralgia type I/II (TNI/II) (medical and surgical failures); trigeminal neuropathic pain; trigeminal deafferentation pain; symptomatic TN
Contributors
Authors
Gaetan Moise, MD

Assistant Professor of Neurological Surgery
Columbia University Medical Center
New York
NY
Disclosures
GM declares that he has no competing interests.
Acknowledgements
Professor Gaetan Moise would like to gratefully acknowledge Professor Christopher J. Winfree, a previous contributor to this monograph. CJW declares that he has no competing interests.
Peer reviewers
Alon Y. Mogilner, MD, PhD
Chief
Section of Functional and Restorative Neurosurgery
North Shore-Long Island Jewish Health System
New York
NY
Disclosures
AYM declares that he has no competing interests.
Richard K. Osenbach, MD
Assistant Professor
Division of Neurosurgery
Duke University Medical Center
Durham
NC
Disclosures
RKO declares that he has no competing interests.
Differentials
- Dental caries
- Dental fracture
- Mandibular osteomyelitis
More DifferentialsGuidelines
- Neuropathic pain in adults: pharmacological management in non-specialist settings
- ACR Appropriateness Criteria: headache
More GuidelinesPatient leaflets
Trigeminal neuralgia
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