Diagnosis of Trigeminal Neuralgia

Trigeminal neuralgia (TN) is a clinical diagnosis based on a patient's description of the pain. There is no specific test to confirm that a patient has TN. Diagnosis is often based on the guidelines published by the International Headache Society which include:

• Paroxysmal (sudden spasm) facial attacks lasting less than two minutes

• Pain must be described with 4 out the following 5 characteristics:

  • pain must follow one or more divisions of the trigeminal nerve
  • pain must be sudden and sharp
  • pain must be of severe intensity
  • pain must be precipitated either by a trigger or by daily activities
  • patient must be pain free between attacks

• There must be no sensory deficit

• Other causes for facial pain must be excluded

The pain is almost always on one side of the face (unilateral). Approximately 3-6% of patients report bilateral pain (pain on both sides of the face) but this is usually concurrent with other conditions such as multiple sclerosis. When pain is bilateral, it is rarely bilateral during the same episode. Usually there is a long interval between the pain affecting the alternate side of the face. The lower face (cheek, jaw) is the most frequent site of the pain, although some patients have pain in their forehead or the entire side of their face. Many patients also complain of pain in their teeth, tongue, or inside the nose. Trigeminal neuralgia affects the right side more than the left side of the face.