Trigeminal Neuralgia in Emergency Medicine Clinical Presentation

Updated: Dec 27, 2017
  • Author: J Stephen Huff, MD, FACEP; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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History is the most important factor in the diagnosis of typical or classical trigeminal neuralgia (TN). Symptomatic trigeminal neuralgia secondary to intracranial processes may have a different history.

Nature of pain

Pain is brief and paroxysmal, but it may occur in volleys of multiple attacks.

Pain is stabbing or shocklike and is typically severe.

Distribution of pain

One or more branches of the trigeminal nerve (usually maxillary or mandibular) are involved.

Pain is unilateral in classical trigeminal neuralgia. Bilateral pain suggests symptomatic trigeminal neuralgia. [1]

Duration of pain is typically from a few seconds to 1-2 minutes. Pain may occur several times a day; patients typically experience no pain between episodes.

Trigger points

Various triggers may commonly precipitate a pain attack. Light touch or vibration is the most provocative.

Activities such as shaving, face washing, or chewing often trigger an episode.

Stimuli as mild as a light breeze may provoke pain in some patients.

Pain provokes brief muscle spasm of the facial muscles, thus producing the tic.



Physical examination findings are normal; in fact, a normal neurologic examination is part of the definition of typical or classic trigeminal neuralgia (TN). Perform a careful examination of the cranial nerves, including the corneal reflex.

  • Be alert to the presence of any abnormality on physical examination. Abnormality suggests that the pain syndrome is secondary to another process.
  • Trigeminal sensory deficits suggest symptomatic trigeminal neuralgia.
  • Remember that patients report pain following stimulation of a trigger point; thus, some patients may limit their examination for fear of stimulating these points.


Most patients' conditions are idiopathic, but compression of the trigeminal roots by tumors or vascular anomalies may cause similar pain (see Pathophysiology).