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Trigeminal Neuralgia Differential Diagnoses

  • Author: Manish K Singh, MD; Chief Editor: Robert A Egan, MD  more...
 
Updated: Oct 22, 2015
 
 

Diagnostic Considerations

Other causes of facial pain than trigeminal neuralgia (TN) are excluded by history, physical examination, and special investigations (when necessary). In symptomatic cases, a persistence of aching can occur between paroxysms, as well as signs of sensory impairment in the trigeminal division. Then, a cause is demonstrated by appropriate investigation.

Migraine, cluster headaches, and atypical face pain

Migraine and cluster headaches may produce severe unilateral pain, but unlike trigeminal neuralgia, these conditions are not triggered by movement or contact with the face nor do they respond promptly to carbamazepine. See Table 1, below.

Table 1. Characteristic Features of 3 Common Craniofacial Pains (Open Table in a new window)

Condition Male:Female Ratio Age of onset, y Localization Accompanying Symptoms Attack Duration Cycles Provocation
Trigeminal neuralgia 1:2 >50 Unilateral None Seconds Month intervals Trigger zones
Cluster headache 31:1 30-40 Always unilateral Horner syndrome, conjunctival injection, epiphora 15-180 minutes Clusters with weeks to months intervals Nocturnal attacks
Migraine 1:1 10-20 Variable Photophobia, phonophobia, gastrointestinal symptoms 4-72 hours Days to weeks intervals Variable

According to Turp and Gobetti, atypical face pain usually extends beyond the distribution of the fifth cranial nerve, is rarely triggered, and presents with a steady unrelenting discomfort lasting hours to days.[19] See Table 2, below.

In persistent idiopathic facial pain, psychiatric disturbances are associated with pain that is of vague localization and long duration (usually chronic and daily). In Raeder syndrome (paratrigeminal neuralgia), ophthalmoparesis is present. In current practice, Raeder syndrome is believed to essentially be carotid dissection. Tolosa-Hunt syndrome (ophthalmoplegia) presents with pain of longer duration but that is not triggerable; cranial nerve deficits are observed. Short-lasting, unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) present with pain of longer duration (2-3 min) and associated prominent autonomic symptoms (eg, lacrimation, rhinorrhea).[20]

Temporomandibular joint pain and dental problems in the evaluation of trigeminal neuralgia.

Table 2. Distinguishing Features Between Trigeminal Neuralgia and Atypical Facial Pain (Open Table in a new window)

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

Glossopharyngeal neuralgia and occipital neuralgia syndromes

Other syndromes with paroxysmal lancinating head pain include the less common glossopharyngeal neuralgia and occipital neuralgia syndromes.

Glossopharyngeal neuralgia causes pain in the tonsillar fossa, posterior pharynx, and ear and may be initiated by coughing, yawning, or swallowing cold liquids. During acute attacks of this condition, which is frequently associated with an underlying pathology, the patient may be unable to speak and tries to avoid moving the lips or tongue. An involuntary startle during an attempt to touch the affected side of the face is diagnostic.

Occipital neuralgia causes pain in the posterior head region. Thus, the distribution easily distinguishes it from trigeminal neuralgia. Confusion arises only if the patient cannot provide a clear history.

Paroxysmal hemicrania syndromes

According to Goadsby and Lipton, similar to trigeminal neuralgia, paroxysmal hemicrania syndromes typically last only seconds, however, the latter syndromes occur in and around 1 eye.[21] Intense unilateral conjunctival injection and lacrimation signal an autonomic component, which further distinguishes paroxysmal hemicrania syndromes. Another feature is that paroxysmal hemicrania syndromes do not respond to carbamazepine.

Secondary vs idiopathic trigeminal neuralgia

Symptomatic or secondary trigeminal neuralgia is a more likely consideration than the idiopathic form when pain is associated with hyperesthesia along the course of the fifth nerve or is observed with other cranial neuropathies. Further, consider secondary trigeminal neuralgia in patients with bilateral sensory loss or weakness of the facial muscles or jaw.

Additional investigation may reveal multiple sclerosis (MS), a tumor in the posterior fossa, or a tumor on the trigeminal nerve.

Acoustic neuromas, cerebral aneurysms, trigeminal neuromas, and meningiomas can produce syndromes similar to idiopathic trigeminal neuralgia. Consider these conditions in patients with onset of pain when younger than 40 years, those with predominant forehead and/or orbit pain (ie, first division of the trigeminal nerve), or those with bilateral facial pain. Also consider granulomatous inflammation (eg, tuberculosis, sarcoidosis, Behçet syndrome, collagen vascular diseases) and other vasculitides, as these may affect the trigeminal nerve and simulate trigeminal neuralgia.

Patients with prominent hemifacial spasm, especially if it is continuous, may have tic convulsif, a condition associated with a dilated and ectatic basilar artery or other vascular malformation compressing the trigeminal nerve.

Brain magnetic resonance imaging (MRI) with and without contrast is critical in diagnosing the secondary causes of trigeminal neuralgia.

Failure to properly assess for secondary trigeminal neuralgia is a major potential pitfall. A careful examination of the cranial nerves and an MRI of the brain, especially in an individual who develops the disorder when younger than 60 years, should protect against missing structural lesions (eg, tumor, cerebral aneurysm, acoustic neuroma).

Trigeminal neuropathy and atypical trigeminal neuralgia

Trigeminal neuropathy is also a consideration in the evaluation of trigeminal neuralgia. This condition presents as a constant, unilateral, often mild facial pain with prominent sensory loss. It is nontriggerable and unremitting, and it may be either symptomatic or idiopathic. By contrast, as previously discussed, idiopathic trigeminal neuralgia presents as episodic, unilateral, lancinating, triggerable, often shocklike facial pain with pain-free intervals.

To further complicate diagnostic matters, the clinician may encounter atypical trigeminal neuralgia, a syndrome that overlaps trigeminal neuralgia and trigeminal neuropathy. This syndrome consists of constant pain that episodically intensifies. According to Burcheil, these patients experience both lancinating triggered pain and a baseline, constant, dull, and throbbing discomfort.[2] The atypical form may occur in up to 5% of people after facial surgery or significant trauma and in 1-5% after the removal of impacted teeth. In the experience of many neurosurgeons, atypical trigeminal neuralgic pain results from lesions or injuries of the trigeminal nerve root distal to the route entry zone but with even greater compression than found in the idiopathic form of trigeminal neuralgia.

In contrast to trigeminal neuropathy, whether typical or atypical, atypical facial pain is distinguished by the extension of discomfort beyond the distribution of the fifth cranial nerve and by the frequent lack of lancinating pain and triggers.

Multiple sclerosis

As discussed in the Clinical section, rarely, multiple sclerosis (MS) presents with trigeminal neuralgia. Consider multiple sclerosis in the diagnostic evaluation of individuals who display other features of this demyelinating disorder.

Herpetic and postherpetic neuralgia

Herpetic and postherpetic neuralgia (PHN) usually affects the first branch of the trigeminal nerve. The diagnosis of postherpetic neuralgia usually requires the outbreak of shingles (herpes zoster) in the forehead or eye. Acute herpetic neuralgia is the norm in shingles, but pain that persists after the lesions have healed is postherpetic neuralgia. The risk of development of postherpetic neuralgia is directly related to patient age.

Differential Diagnoses

 
 
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 Headache Society, American Association of Physicians of Indian Origin, American Medical Association, American Society of Regional Anesthesia and Pain Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Gordon H Campbell, MSN FNP-BC, Neuroscience Nurse Practitioner, Neurology Service, Portland Veterans Affairs Medical Center; Primary Faculty, Clinical Instructor, and Guest Lecturer, Family Nursing Department, Oregon Health Sciences University School of Nursing

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 and Vice Chair, Department of Neurology, Oregon Health and Science University School of Medicine; Associate Director, OHSU Stroke Center

Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology, American Stroke Association

Disclosure: Medscape Neurology Editorial Advisory Board for: Stroke Adjudication Committee, CREST2.

Siddharth Gautam, MBBS Resident Physician, Jersey Neuroscience Institute

Disclosure: Nothing to disclose.

Chief Editor

Robert A Egan, MD Director of Neuro-Ophthalmology and Stroke Service, 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, Oregon Medical Association

Disclosure: Received honoraria from Biogen Idec for speaking and teaching; Received honoraria from Teva for speaking and teaching.

Acknowledgements

Jane W Chan, MD Professor of Neurology/Neuro-ophthalmology, Department of Medicine, Division of Neurology, University of Nevada School of Medicine

Jane W Chan, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Ophthalmology, American Medical Association, North American Neuro-Ophthalmology Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

James R Couch, MD, PhD, FACP Professor of Neurology, University of Oklahoma Health Sciences Center

Disclosure: Nothing to disclose.

Theodore J Gaeta, DO, MPH, FACEP Clinical Associate Professor, Department of Emergency Medicine, Weill Cornell Medical College; Vice Chairman and Program Director of Emergency Medicine Residency Program, Department of Emergency Medicine, New York Methodist Hospital; Academic Chair, Adjunct Professor, Department of Emergency Medicine, St George's University School of Medicine

Theodore J Gaeta, DO, MPH, FACEP is a member of the following medical societies: Alliance for Clinical Education, American College of Emergency Physicians, Clerkship Directors in Emergency Medicine, Council of Emergency Medicine Residency Directors, New York Academy of Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

J Stephen Huff, MD Associate Professor of Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia School of Medicine

J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Andrew W Lawton, MD Medical Director of Neuro-Ophthalmology Service, Section of Ophthalmology, Baptist Eye Center, Baptist Health Medical Center

Andrew W Lawton, MD is a member of the following medical societies: American Academy of Ophthalmology, Arkansas Medical Society, and Southern Medical Association

Disclosure: Nothing to disclose.

Marc E Lenaerts, MD, FAHS Staff Neurologist, Mercy Medical Group; Associate Clinical Professor of Neurology, Department of Neurology, University of California, Davis, School of Medicine

Marc E Lenaerts, MD, FAHS is a member of the following medical societies: American Academy of Neurology, American Headache Society, and International Headache Society

Disclosure: Nothing to disclose.

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.

Hampton Roy Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Tom Scaletta, MD Chair, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine

Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Brian R Younge, MD Professor of Ophthalmology, Mayo Clinic School of Medicine

Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.

References
  1. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004. 24 Suppl 1:9-160. [Medline].

  2. Burcheil KJ. Trigeminal neuralgia. In: Conn's Current Therapy. 1999:948-50.

  3. Osler W. The principles and practice of medicine. 8th ed. 1912:191-202.

  4. Burchiel KJ. Abnormal impulse generation in focally demyelinated trigeminal roots. J Neurosurg. 1980 Nov. 53(5):674-83. [Medline].

  5. Devor M, Amir R, Rappaport ZH. Pathophysiology of trigeminal neuralgia: the ignition hypothesis. Clin J Pain. 2002 Jan-Feb. 18(1):4-13. [Medline].

  6. Anderson VC, Berryhill PC, Sandquist MA, Ciaverella DP, Nesbit GM, Burchiel KJ. High-resolution three-dimensional magnetic resonance angiography and three-dimensional spoiled gradient-recalled imaging in the evaluation of neurovascular compression in patients with trigeminal neuralgia: a double-blind pilot study. Neurosurgery. 2006 Apr. 58(4):666-73; discussion 666-73. [Medline].

  7. Hess B, Oberndorfer S, Urbanits S, Lahrmann H, Horvath-Mechtler B, Grisold W. Trigeminal neuralgia in two patients with glioblastoma. Headache. 2005 Oct. 45(9):1267-70. [Medline].

  8. Cheshire WP Jr. The shocking tooth about trigeminal neuralgia. N Engl J Med. 2000 Jun 29. 342(26):2003. [Medline].

  9. Cheshire WP Jr, Wharen RE Jr. Trigeminal neuralgia in a patient with spontaneous intracranial hypotension. Headache. 2009 May. 49(5):770-3. [Medline].

  10. Penman J. Trigeminal neuralgia. In: Vinkin PJ, Bruyn GW, eds. Handbook of Clinical Neurology. Vol 55. 1968:296-322.

  11. Mauskop A. Trigeminal neuralgia (tic douloureux). J Pain Symptom Manage. 1993 Apr. 8(3):148-54. [Medline].

  12. Rushton JG, Olafson RA. Trigeminal neuralgia associated with multiple sclerosis. A case report. Arch Neurol. 1965 Oct. 13(4):383-6. [Medline].

  13. Jensen TS, Rasmussen P, Reske-Nielsen E. Association of trigeminal neuralgia with multiple sclerosis: clinical and pathological features. Acta Neurol Scand. 1982 Mar. 65(3):182-9. [Medline].

  14. Limonadi FM, McCartney S, Burchiel KJ. Design of an artificial neural network for diagnosis of facial pain syndromes. Stereotact Funct Neurosurg. 2006. 84(5-6):212-20. [Medline].

  15. Fromm GH, Terrence CF, Chattha AS, Glass JD. Baclofen in trigeminal neuralgia: its effect on the spinal trigeminal nucleus: a pilot study. Arch Neurol. 1980 Dec. 37(12):768-71. [Medline].

  16. Patten J. Trigeminal neuralgia. In: Neurological Differential Diagnosis. 2nd ed. London: Springer. 1996:373-5.

  17. Sands GH. Pain in the face. Headaches in Adults, Annual Course, American Academy of Neurology Annual Meeting. 1994. 3:146:130-2.

  18. Eller JL, Raslan AM, Burchiel KJ. Trigeminal neuralgia: definition and classification. Neurosurg Focus. 2005 May 15. 18(5):E3. [Medline].

  19. Türp JC, Gobetti JP. Trigeminal neuralgia versus atypical facial pain. A review of the literature and case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996 Apr. 81(4):424-32. [Medline].

  20. Vincent M. SUNCT, lacrimation, and trigeminal neuralgia. Cephalalgia. 1998 Mar. 18(2):71. [Medline].

  21. Goadsby PJ, Lipton RB. A review of paroxysmal hemicranias, SUNCT syndrome and other short-lasting headaches with autonomic feature, including new cases. Brain. 1997 Jan. 120 (Pt 1):193-209. [Medline].

  22. Majoie CB, Hulsmans FJ, Castelijns JA, Verbeeten B Jr, Tiren D, van Beek EJ, et al. Symptoms and signs related to the trigeminal nerve: diagnostic yield of MR imaging. Radiology. 1998 Nov. 209(2):557-62. [Medline].

  23. Gronseth G, Cruccu G, Alksne J, Argoff C, Brainin M, Burchiel K, 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. [Medline].

  24. Tanaka T, Morimoto Y, Shiiba S, Sakamoto E, Kito S, Matsufuji Y, et al. Utility of magnetic resonance cisternography using three-dimensional fast asymmetric spin-echo sequences with multiplanar reconstruction: the evaluation of sites of neurovascular compression of the trigeminal nerve. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Aug. 100(2):215-25. [Medline].

  25. Cruccu G, Biasiotta A, Galeotti F, Iannetti GD, Truini A, Gronseth G. Diagnostic accuracy of trigeminal reflex testing in trigeminal neuralgia. Neurology. 2006 Jan 10. 66(1):139-41. [Medline].

  26. Eller JL, Raslan AM, Burchiel KJ. Trigeminal neuralgia: definition and classification. Neurosurg Focus. 2005 May 15. 18(5):E3. [Medline].

  27. Blom S. Trigeminal neuralgia: its treatment with a new anticonvulsant drug (G-32883). Lancet. 1962 Apr 21. 1:839-40. [Medline].

  28. Dalessio DJ. Trigeminal neuralgia. A practical approach to treatment. Drugs. 1982 Sep. 24(3):248-55. [Medline].

  29. Campbell FG, Graham JG, Zilkha KJ. Clinical trial of carbazepine (tegretol) in trigeminal neuralgia. J Neurol Neurosurg Psychiatry. 1966 Jun. 29(3):265-7. [Medline]. [Full Text].

  30. Rockliff BW, Davis EH. Controlled sequential trials of carbamazepine in trigeminal neuralgia. Arch Neurol. 1966 Aug. 15(2):129-36. [Medline].

  31. Beydoun A. Safety and efficacy of oxcarbazepine: results of randomized, double-blind trials. Pharmacotherapy. 2000 Aug. 20(8 Pt 2):152S-158S. [Medline].

  32. Sist T, Filadora V, Miner M, Lema M. Gabapentin for idiopathic trigeminal neuralgia: report of two cases. Neurology. 1997 May. 48(5):1467. [Medline].

  33. Khan OA. Gabapentin relieves trigeminal neuralgia in multiple sclerosis patients. Neurology. 1998 Aug. 51(2):611-4. [Medline].

  34. Solaro C, Lunardi GL, Capello E, et al. An open-label trial of gabapentin treatment of paroxysmal symptoms in multiple sclerosis patients. Neurology. 1998 Aug. 51(2):609-11. [Medline].

  35. Chogtu B, Bairy KL, Smitha D, Dhar S, Himabindu P. Comparison of the efficacy of carbamazepine, gabapentin and lamotrigine for neuropathic pain in rats. Indian J Pharmacol. 2011 Sep. 43(5):596-8. [Medline]. [Full Text].

  36. Carrazana EJ, Schachter SC. Alternative uses of lamotrigine and gabapentin in the treatment of trigeminal neuralgia. Neurology. 1998 Apr. 50(4):1192. [Medline].

  37. Lunardi G, Leandri M, Albano C, et al. Clinical effectiveness of lamotrigine and plasma levels in essential and symptomatic trigeminal neuralgia. Neurology. 1997 Jun. 48(6):1714-7. [Medline].

  38. Zakrzewska JM, Chaudhry Z, Nurmikko TJ, et al. Lamotrigine (lamictal) in refractory trigeminal neuralgia: results from a double-blind placebo controlled crossover trial. Pain. 1997 Nov. 73(2):223-30. [Medline].

  39. Loeser JD. The management of tic douloureux. Pain. 1977 Apr. 3(2):155-62. [Medline].

  40. Braham J. Pain in the face. Br Med J. 1968 Aug 3. 3(5613):316. [Medline]. [Full Text].

  41. Raskin NH. Trigeminal neuralgia. 2nd ed. 1988.

  42. He L, Wu B, Zhou M. Non-antiepileptic drugs for trigeminal neuralgia. Cochrane Database Syst Rev. 2006 Jul 19. 3:CD004029. [Medline].

  43. Baker KA, Taylor JW, Lilly GE. Treatment of trigeminal neuralgia: use of baclofen in combination with carbamazepine. Clin Pharm. 1985 Jan-Feb. 4(1):93-6. [Medline].

  44. Fromm GH, Terrence CF, Chattha AS. Baclofen in the treatment of trigeminal neuralgia: double-blind study and long-term follow-up. Ann Neurol. 1984 Mar. 15(3):240-4. [Medline].

  45. Parekh S, Shah K, Kotdawalla H. Baclofen in carbamazepine resistant trigeminal neuralgia - a double-blind clinical trial. Cephalalgia. 1989. 9 (Suppl 10):392-3.

  46. Fromm GH, Terrence CF. Comparison of L-baclofen and racemic baclofen in trigeminal neuralgia. Neurology. 1987 Nov. 37(11):1725-8. [Medline].

  47. Gilron I, Booher SL, Rowan MS, et al. A randomized, controlled trial of high-dose dextromethorphan in facial neuralgias. Neurology. 2000 Oct 10. 55(7):964-71. [Medline].

  48. Allam N, Brasil-Neto JP, Brown G, Tomaz C. Injections of botulinum toxin type a produce pain alleviation in intractable trigeminal neuralgia. Clin J Pain. 2005 Mar-Apr. 21(2):182-4. [Medline].

  49. DMKG study group. Misoprostol in the treatment of trigeminal neuralgia associated with multiple sclerosis. J Neurol. 2003 May. 250(5):542-5. [Medline].

  50. Tatli M, Satici O, Kanpolat Y, Sindou M. Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes. Acta Neurochir (Wien). 2008 Mar. 150(3):243-55. [Medline].

  51. [Guideline] International RadioSurgery Association. Stereotactic radiosurgery for patients with intractable typical trigeminal neuralgia who have failed medical management. Harrisburg, Pa: IRSA; 2009. (Radiosurgery practice guideline report; no. 1-03). Available at http://guideline.gov/content.aspx?id=14309. Accessed: April 8, 2011.

  52. Sweet WH. Percutaneous methods for the treatment of trigeminal neuralgia and other faciocephalic pain; comparison with microvascular decompression. Semin Neurol. 1988 Dec. 8(4):272-9. [Medline].

  53. Pollock BE, Ecker RD. A prospective cost-effectiveness study of trigeminal neuralgia surgery. Clin J Pain. 2005 Jul-Aug. 21(4):317-22. [Medline].

  54. Olson S, Atkinson L, Weidmann M. Microvascular decompression for trigeminal neuralgia: recurrences and complications. J Clin Neurosci. 2005 Sep. 12(7):787-9. [Medline].

  55. Barbor, M. MVD Bests Gamma Knife for Pain in Trigeminal Neuralgia. Medscape Medical News. Available at http://www.medscape.com/viewarticle/852161. October 5, 2015; Accessed: October 22, 2015.

  56. Zakrzewska JM, Thomas DG. Patient's assessment of outcome after three surgical procedures for the management of trigeminal neuralgia. Acta Neurochir (Wien). 1993. 122(3-4):225-30. [Medline].

  57. Asplund P, Blomstedt P, Bergenheim AT. Percutaneous Balloon Compression vs Percutaneous Retrogasserian Glycerol Rhizotomy for the Primary Treatment of Trigeminal Neuralgia. Neurosurgery. 2015 Oct 13. [Medline].

  58. Tan LK, Robinson SN, Chatterjee S. Glycerol versus radiofrequency rhizotomy - a comparison of their efficacy in the treatment of trigeminal neuralgia. Br J Neurosurg. 1995 Apr. 9(2):165-9. [Medline].

  59. Cappabianca P, Spaziante R, Graziussi G, et al. Percutaneous retrogasserian glycerol rhizolysis for treatment of trigeminal neuralgia. Technique and results in 191 patients. J Neurosurg Sci. 1995 Mar. 39(1):37-45. [Medline].

  60. Taha JM, Tew JM Jr. Treatment of trigeminal neuralgia by percutaneous radiofrequency rhizotomy. Neurosurg Clin N Am. 1997 Jan. 8(1):31-9. [Medline].

  61. Meglio M, Cioni B. Percutaneous procedures for trigeminal neuralgia: microcompression versus radiofrequency thermocoagulation. Personal experience. Pain. 1989 Jul. 38(1):9-16. [Medline].

  62. Leksell L. Stereotactic radiosurgery in trigeminal neuralgia. Acta Chem Scand. 1971. 37:311-314.

  63. Kondziolka D, Lunsford LD, Flickinger JC, et al. Stereotactic radiosurgery for trigeminal neuralgia: a multi-institutional study using the gamma unit. J Neurosurg. 1996 Jun. 84(6):940-5. [Medline].

  64. Kondziolka D, Perez B, Flickinger JC, et al. Gamma knife radiosurgery for trigeminal neuralgia: results and expectations. Arch Neurol. 1998 Dec. 55(12):1524-9. [Medline].

  65. Deinsberger R, Tidstrand J. Linac radiosurgery as a tool in neurosurgery. Neurosurg Rev. 2005 Apr. 28(2):79-88; discussion 89-90, 91. [Medline].

  66. Kondziolka D, Lemley T, Kestle JR, Lunsford LD, Fromm GH, Jannetta PJ. The effect of single-application topical ophthalmic anesthesia in patients with trigeminal neuralgia. A randomized double-blind placebo-controlled trial. J Neurosurg. 1994 Jun. 80(6):993-7. [Medline].

  67. Türk U, Ilhan S, Alp R, Sur H. Botulinum toxin and intractable trigeminal neuralgia. Clin Neuropharmacol. 2005 Jul-Aug. 28(4):161-2. [Medline].

  68. Gilron I, Booher SL, Rowan JS, Max MB. Topiramate in trigeminal neuralgia: a randomized, placebo-controlled multiple crossover pilot study. Clin Neuropharmacol. 2001 Mar-Apr. 24(2):109-12. [Medline].

  69. Zvartau-Hind M, Din MU, Gilani A, et al. Topiramate relieves refractory trigeminal neuralgia in MS patients. Neurology. 2000 Nov 28. 55(10):1587-8. [Medline].

  70. Farago F. Trigeminal neuralgia: its treatment with two new carbamazepine analogues. Eur Neurol. 1987. 26(2):73-83. [Medline].

  71. Beydown A, et al. Meta-analysis of comparative trials of oxcarbazepine versus carbamazepine in trigeminal neuralgia. Oxcarbazepine Study Group. Poster presented at the 21st American Pain Society Annual Meeting, Baltimore, Md; Mar 14-17, 2002.

  72. Bender MT, Pradilla G, Batra S, See AP, James C, Pardo CA, et al. Glycerol rhizotomy and radiofrequency thermocoagulation for trigeminal neuralgia in multiple sclerosis. J Neurosurg. 2013 Feb. 118(2):329-36. [Medline].

  73. Jorns TP, Zakrzewska JM. Evidence-based approach to the medical management of trigeminal neuralgia. Br J Neurosurg. 2007 Jun. 21(3):253-61. [Medline].

  74. Sandell T, Eide PK. Effect of microvascular decompression in trigeminal neuralgia patients with or without constant pain. Neurosurgery. 2008 Jul. 63(1):93-9; discussion 99-100. [Medline].

  75. Truini A, Galeotti F, Haanpaa M, Zucchi R, Albanesi A, Biasiotta A, et al. Pathophysiology of pain in postherpetic neuralgia: A clinical and neurophysiological study. Pain. 2008 Oct 25. [Medline].

 
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Illustration depicting the trigeminal nerve with its 3 main branches
Microscopic demonstration of demyelination in primary trigeminal neuralgia. A tortuous axon is surrounded by abnormally discontinuous myelin. (Electron microscope; 3300×).
Magnetic resonance image (MRI) with high resolution on the pons demonstrating the trigeminal nerve root. In this case, the patient with trigeminal neuralgia has undergone gamma-knife therapy, and the left-sided treated nerve (arrow) is enhanced by gadolinium.
Microvascular decompression (Jannetta procedure) used to treat trigeminal neuralgia. The anteroinferior cerebellar artery and the trigeminal nerve are in direct contact. Courtesy of PT Dang, CH Luxembourg
Table 1. Characteristic Features of 3 Common Craniofacial Pains
Condition Male:Female Ratio Age of onset, y Localization Accompanying Symptoms Attack Duration Cycles Provocation
Trigeminal neuralgia 1:2 >50 Unilateral None Seconds Month intervals Trigger zones
Cluster headache 31:1 30-40 Always unilateral Horner syndrome, conjunctival injection, epiphora 15-180 minutes Clusters with weeks to months intervals Nocturnal attacks
Migraine 1:1 10-20 Variable Photophobia, phonophobia, gastrointestinal symptoms 4-72 hours Days to weeks intervals Variable
Table 2. Distinguishing Features Between Trigeminal Neuralgia and Atypical Facial Pain
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
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