Evaluation of suspected trigeminal neuralgia

TN is a common cause of unilateral facial pain characterized by recurrent attacks of severe, electric-like pain. A clinical diagnosis of TN is made in patients with characteristic features, and neuroimaging is performed to identify or exclude underlying causes that may warrant additional treatment. Refer to UpToDate topic on trigeminal neuralgia for additional details.

MRA: magnetic resonance angiography; MRI: magnetic resonance imaging; TN: trigeminal neuralgia.

* Cranial autonomic features include conjunctival injection, lacrimation, rhinorrhea, eyelid edema, ptosis, hemifacial sweating, and miosis. Some patients with TN may have mild cranial autonomic symptoms in the ophthalmic division of the trigeminal nerve, but more prominent or severe symptoms are more consistent with a trigeminal autonomic cephalalgia (eg, cluster headache).

¶ Common alternative causes of facial pain include trigeminal neuropathy, odontogenic conditions, and trigeminal autonomic cephalalgias. Refer to the differential diagnosis of trigeminal neuralgia for additional information.

Δ Vascular compression may also lead to morphologic changes of the trigeminal nerve root such as distortion of the normal course or atrophy.

◊ Refer to UpToDate topic for details on symptomatic treatment of TN.

§ Structural causes of TN that may warrant additional treatment include tumors of the cerebropontine angle, demyelination due to multiple sclerosis, or brainstem arteriovenous malformations. Refer to UpToDate topics for additional treatment details.

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Evaluation of suspected trigeminal neuralgia