eMedicine Specialties > Neurology > Headache and Pain
Trigeminal Neuralgia: Differential Diagnoses & Workup
Updated: Aug 21, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Differential Diagnoses
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
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Table
| Feature | Trigeminal Neuralgia | Atypical Facial Pain |
| Prevalence | Rare | Common |
| Main location | Trigeminal area | Face, neck, ear |
| Pain duration | Seconds to 2 minutes | Hours to days |
| Character | Electric jerks, stabbing | Throbbing, dull |
| Pain intensity | Severe | Mild to moderate |
| Provoking factors | Light touch, washing, shaving, eating, talking | Stress, cold |
| Associated symptoms | None | Sensory abnormalities |
| Feature | Trigeminal Neuralgia | Atypical Facial Pain |
| Prevalence | Rare | Common |
| Main location | Trigeminal area | Face, neck, ear |
| Pain duration | Seconds to 2 minutes | Hours to days |
| Character | Electric jerks, stabbing | Throbbing, dull |
| Pain intensity | Severe | Mild to moderate |
| Provoking factors | Light touch, washing, shaving, eating, talking | Stress, cold |
| Associated symptoms | None | Sensory 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
Differential Diagnoses & Workup: Trigeminal Neuralgia