eMedicine Specialties > Neurology > Headache and Pain

Trigeminal Neuralgia: Differential Diagnoses & Workup

Author: Manish K Singh, MD, Assistant Professor, Department of Neurology, Teaching Faculty for Pain Management and Neurology Residency Program, Hahnemann University Hospital, Drexel College of Medicine; Medical Director, Neurology and Pain Management, Jersey Institute of Neuroscience
Coauthor(s): Gordon H Campbell, MSN, Senior Nurse Practitioner, Department of Mental Health and Neuroscience, Portland Veterans Affairs Medical Center; Helmi L Lutsep, MD, Professor, Department of Neurology, Oregon Health & Science University; Associate Director, Oregon Stroke Center; Siddharth Gautam, MBBS, Resident Physician, Jersey Neuroscience Institute
Contributor Information and Disclosures

Updated: Aug 21, 2009

Differential Diagnoses

Arteriovenous Malformations
Low-Grade Astrocytoma
Brainstem Gliomas
Meningioma
Cavernous Sinus Syndromes
Migraine Headache
Cerebral Aneurysms
Migraine Headache: Neuro-Ophthalmic Perspective
Chronic Paroxysmal Hemicrania
Migraine Variants
Cluster Headache
Multiple Sclerosis
Craniopharyngioma
Persistent Idiopathic Facial Pain
Glioblastoma Multiforme
Polyarteritis Nodosa
Hemifacial Spasm
Postherpetic Neuralgia
Hydrocephalus
Subarachnoid Hemorrhage
Intracranial Hemorrhage

Other Problems to Be Considered

Atypical facial pain
Glossopharyngeal neuralgia
Occipital neuralgia
Posterior fossa tumor
Tic convulsif
Trigeminal neuropathy
Acoustic neuroma
Brainstem syndromes
Chronic pain programs
Granulomatous angiitis
Malignant and non-malignant pain syndromes
Ramsay-Hunt syndrome
Sarcoidosis

Distinguishing Features Between Trigeminal Neuralgia and Atypical Facial Pain

Open table in new window

Table
Feature Trigeminal Neuralgia Atypical Facial Pain
PrevalenceRareCommon
Main locationTrigeminal areaFace, neck, ear
Pain durationSeconds to 2 minutesHours to days
CharacterElectric jerks, stabbingThrobbing, dull
Pain intensitySevereMild to moderate
Provoking factorsLight touch, washing, shaving, eating, talkingStress, cold
Associated symptomsNoneSensory abnormalities
Feature Trigeminal Neuralgia Atypical Facial Pain
PrevalenceRareCommon
Main locationTrigeminal areaFace, neck, ear
Pain durationSeconds to 2 minutesHours to days
CharacterElectric jerks, stabbingThrobbing, dull
Pain intensitySevereMild to moderate
Provoking factorsLight touch, washing, shaving, eating, talkingStress, cold
Associated symptomsNoneSensory abnormalities

Workup

Laboratory Studies

No laboratory, electrophysiologic, or radiologic testing routinely is indicated for diagnosis.

Imaging Studies

  • Brain MRI with and without contrast helps to distinguish secondary causes of trigeminal neuralgia (TN) from the idiopathic form. The study is indicated in patients presenting with the condition when younger than 60 years, principally to exclude tumor.
  • In patients older than 60 years, the clinician may first choose to assess the response to a therapeutic trial of medication before considering imaging. A clear relief of pain with carbamazepine or another anticonvulsant confirms the diagnosis of idiopathic TN.
  • Rarely, multiple sclerosis (MS) presents with TN. Consider MS in the diagnostic evaluation of individuals who display other features of this demyelinating disorder.

Other Tests

No other diagnostic testing is indicated.

Procedures

No further procedures are indicated for the diagnosis of this disorder.

More on Trigeminal Neuralgia

Overview: Trigeminal Neuralgia
Differential Diagnoses & Workup: Trigeminal Neuralgia
Treatment & Medication: Trigeminal Neuralgia
Follow-up: Trigeminal Neuralgia
References

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Further Reading

Keywords

trigeminal neuralgia, tic douloureux, TN, facial pain syndrome, facial pain, pain syndrome, carbamazepine therapy, carbamazepine, ICD-9 350-1, atypical facial pain, gamma knife surgery, trigeminal neuralgia symptoms, trigeminal neuralgia causes, trigeminal neuralgia treatment, trigeminal neuralgia medication, trigeminal neuralgia surgery, facial nerve pain, cranial nerve pain

Contributor Information and Disclosures

Author

Manish K Singh, MD, Assistant Professor, Department of Neurology, Teaching Faculty for Pain Management and Neurology Residency Program, Hahnemann University Hospital, Drexel College of Medicine; Medical Director, Neurology and Pain Management, Jersey Institute of Neuroscience
Manish K Singh, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American Association of Physicians of Indian Origin, American Headache Society, American Medical Association, and American Society of Regional Anesthesia and Pain Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Gordon H Campbell, MSN, Senior Nurse Practitioner, Department of Mental Health and Neuroscience, Portland Veterans Affairs Medical Center
Gordon H Campbell, MSN is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Helmi L Lutsep, MD, Professor, Department of Neurology, Oregon Health & Science University; Associate Director, Oregon Stroke Center
Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology and American Stroke Association
Disclosure: Co-Axia Consulting fee Review panel membership; Talecris Consulting fee Review panel membership; AGA Medical Consulting fee Review panel membership; Boehringer Ingelheim Honoraria Speaking and teaching; Concentric Medical Consulting fee Review panel membership; Abbott Consulting fee Consulting; Sanofi  Consulting

Siddharth Gautam, MBBS, Resident Physician, Jersey Neuroscience Institute
Disclosure: Nothing to disclose.

Medical Editor

Jorge E Mendizabal, MD, Consulting Staff, Corpus Christi Neurology
Jorge E Mendizabal, MD is a member of the following medical societies: American Academy of Neurology, American Headache Society, National Stroke Association, and Stroke Council of the American Heart Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

James H Halsey, MD, Professor, Department of Neurology, University of Alabama Medical Center
James H Halsey, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neuroimaging, Medical Association of the State of Alabama, New York Academy of Sciences, Pan American Medical Association, Sigma Xi, Society for Neuroscience, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Robert A Egan, MD, Director of Neuro-Ophthalmology, St Helena Hospital
Robert A Egan, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, North American Neuro-Ophthalmology Society, and Oregon Medical Association
Disclosure: Nothing to disclose.

 
 
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