TOC  | ID |  Neurology

Trigeminal Neuralgia    REF:  ACP- PIER

H & P  |  Diff-Dx  |  Rx   


Consider the diagnosis of trigeminal neuralgia (tic douloureux) in patients with unilateral face pain of an electric shock-like or shooting quality that lasts less than one minute, is paroxysmal with pain-free intervals, and is triggered by light touch.
Trigeminal neuralgia is the most common craniofacial pain syndrome of neuropathic origin.  The diagnosis remains based exclusively on history and symptomatology.  


  1. Duration of pain
  2. Quality of pain
  3. Triggers of pain
  4. Location of pain
  5. Frequency of pain
  6. Severity of pain
  7. Refractory period of pain after stimulation of the trigger area (cannot elicit pain again by touching or pushing immediately after a painful attack)
  8. Rash
  9. Nasal discharge
  10. Other neurologic symptoms

Physical Exam

  1. Neurologic exam  
  2. Dental exam
  3. ENT exam

Laboratory Tests

Differential Diagnosis of Trigeminal Neuralgia         

Differential Diagnosis of Trigeminal Neuralgia

  1. Dental pain
  2. Sinus disease
  3. Temporomandibular joint disease
  4. Postherpetic neuralgia
  5. Vascular dysfunction (migraine variants)
  6. Inflammatory vascular disease (temporal arteritis)
  7. Deafferentation pain
  8. Atypical trigeminal neuralgia
  9. Vagoglossopharyngeal neuralgia
  10. Atypical facial pains

Non-drug Therapy        
Although there are no known nonsurgical therapies that influence the course of trigeminal neuralgia, suggest certain maneuvers that may make the condition more tolerable.

Drug Treatment for Trigeminal Neuralgia   (Agent | Mechanism of Action | Dosage | Benefits | Side Effects | Notes )       
Consider long-term drug treatment for prevention of further attacks of trigeminal neuralgia.

Carbamazepine (Tegretol)

Oxcarbazepine (Trileptal)

Gabapentin (Neurontin)

Phenytoin (Dilantin)

Lamotrigine (Lamictal)

Baclofen (Lioresal)

Narcotics (none has been shown to be more effective than others)