Trigeminal neuralgia

Last reviewed: 3 Jun 2022
Last updated: 24 Jul 2018

Summary

Definition

History and exam

Key diagnostic factors

  • facial pain
More key diagnostic factors

Other diagnostic factors

  • prior oropharyngeal or facial trauma
  • prior herpetic outbreak
  • 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

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

Treatment algorithm

ACUTE

newly-diagnosed trigeminal neuralgia (TN)

anticonvulsant-unresponsive trigeminal neuralgia (TN)

ONGOING

medication-unresponsive trigeminal neuralgia type I (TNI)

medication-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
Gaetan Moise

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 Differentials
  • Guidelines

    • ACR Appropriateness Criteria: headache
    • EFNS guidelines on the pharmacological treatment of neuropathic pain, 2010 revision
    More Guidelines
  • Patient leaflets

    Trigeminal neuralgia

    More Patient leaflets
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