Summary
Definition
History and exam
Key diagnostic factors
- stereotyped paroxysms of facial pain
- attacks triggered by facial or oral mechanical stimulation
Other diagnostic factors
- sensory/motor changes
Risk factors
- increased age
- multiple sclerosis
- female
- hypertension
Diagnostic tests
1st tests to order
- no first test
Tests to consider
- MRI
- trigeminal reflex testing
- intraoral radiographs
Treatment algorithm
newly diagnosed trigeminal neuralgia (TN)
medication-unresponsive classical trigeminal neuralgia
medication-unresponsive idiopathic trigeminal neuralgia
medication-unresponsive secondary trigeminal neuralgia
Contributors
Authors
Gaetan Moise, MD

Clinical Instructor of Neurological Surgery
New York University Langone 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 topic.
Disclosures
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.
References
Key articles
Cruccu G, Finnerup NB, Jensen TS, et al. Trigeminal neuralgia: new classification and diagnostic grading for practice and research. Neurology. 2016 Jul 12;87(2):220-8.Full text Abstract
Bendtsen L, Zakrzewska JM, Abbott J, et al. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol. 2019 Jun;26(6):831-49.Full text Abstract
Gronseth G, Cruccu G, Alksne J, et al. Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology. 2008 Oct 7;71(15):1183-90.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Dental caries
- Dental fracture
- Mandibular osteomyelitis
More DifferentialsGuidelines
- ACR Appropriateness Criteria: cranial neuropathy
- ACR Appropriateness Criteria: headache
More GuidelinesPatient information
Trigeminal neuralgia
More Patient informationLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer