Trigeminal neuralgia

Last reviewed: 6 May 2023
Last updated: 03 Mar 2023

Summary

Definition

History and exam

Key diagnostic factors

  • stereotyped paroxysms of facial pain
  • attacks triggered by facial or oral mechanical stimulation
More key diagnostic factors

Other diagnostic factors

  • sensory/motor changes
Other diagnostic factors

Risk factors

  • increased age
  • multiple sclerosis
  • female
  • hypertension
More risk factors

Diagnostic investigations

1st investigations to order

  • no first test
More 1st investigations to order

Investigations to consider

  • MRI
  • trigeminal reflex testing
  • intraoral radiographs
More investigations to consider

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, MD
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.

Acknowledgements

Professor Gaetan Moise would like to gratefully acknowledge Professor Christopher J. Winfree, a previous contributor to this topic. 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
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  • Guidelines

    • ACR Appropriateness Criteria: cranial neuropathy​​
    • ACR Appropriateness Criteria: headache​
    More Guidelines
  • Patient leaflets

    Trigeminal neuralgia

    More Patient leaflets
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