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Trigeminal neuralgia

Last reviewed: 5 Apr 2025
Last updated: 19 Mar 2025

Summary

Definition

History and exam

Key diagnostic factors

  • stereotyped paroxysms of facial pain
  • attacks triggered by facial or oral mechanical stimulation
Full details

Other diagnostic factors

  • sensory/motor changes
Full details

Risk factors

  • increased age
  • multiple sclerosis
  • female
  • hypertension
Full details

Diagnostic tests

1st tests to order

  • no first test
Full details

Tests to consider

  • MRI
  • trigeminal reflex testing
  • intraoral radiographs
Full details

Treatment algorithm

ACUTE

newly diagnosed trigeminal neuralgia (TN)

ONGOING

medication-unresponsive classical trigeminal neuralgia

medication-unresponsive idiopathic trigeminal neuralgia

medication-unresponsive secondary trigeminal neuralgia

Contributors

Authors

Gaetan Moise

Clinical Instructor of Neurological Surgery

New York University Langone Medical Center

New York

NY

Disclosures

GM declares that he has no competing interests.

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

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.

Assistant Professor

Division of Neurosurgery

Duke University Medical Center

Durham

NC

Disclosures

RKO declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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.
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