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Facial pain may occur as a result of several conditions. These conditions must be excluded before the doctor reaches a diagnosis of trigeminal neuralgia (TN).

Other possible causes of facial pain that must be taken into consideration include:

• Otitis media (ear infection)
• Sinusitis
• Acute glaucoma - may cause pain around the eyes
• "Phantom" tooth pain following tooth extraction
• Post-herpetic neuralgia - often described as burning or throbbing pain following a herpes simplex or zoster outbreak
• Glossopharyngeal neuralgia - presents with intense pain deep in the throat or in the base of the tongue. It is very rare and associated with irritation of the glossopharyngeal nerve.
• Vagal and superior laryngeal neuralgia - presents with pain similar to TN (shock-like) but the location of the pain is around the thyroid gland. This is a very rare condition.
• Cluster headache - usually accompanied by eye tearing and/or rhinitis (runny nose), sweating and other symptoms.
• SUNCT syndrome (abbreviation for "short lasting, unilateral, neuralgiform pain with conjunctival injection and tearing") - a rare type of headache common in men over age 50 which is characterized by burning or stabbing pain on one side of the face, usually around the eye or temple. It is often accompanied by tearing and redness of the eye.
• Cerebral aneurysm - if a brain aneurysm (a section of the wall of an artery is weakened, causing dilation) is actively growing, it may produce facial pain or pain around the eye.
• Temporomandibular Joint Disorder (TMJD) - often presents as a dull ache exacerbated by chewing. TMJ often involves muscle soreness and is associated with continuous pain that may fluctuate in intensity but is not intermittent.
• Atypical facial pain syndromes - can present with symptoms similar to TN but it usually does not interfere in the quality of life to the extent of trigeminal neuralgia. It can be bilateral or unilateral, oral or facial, and usually does not respond to medications or surgeries that are effective for TN.
• Myofascial pain syndromes - pain is described as aching and burning and is usually located in the lateral part of the face.
• Hemifacial spasm (tic convulsif) - can cause tics which are usually not painful and at least initially affects one side of the face. It is thought to be caused by irritation of the 7th cranial nerve.