Diagnosing Trigeminal Neuralgia

What is trigeminal neuralgia?

Trigeminal neuralgia is a neuropathic pain condition which develops when damage occurs to a trigeminal nerve. The trigeminal nerves are the main nerves on each side of the face — each side of the face contains one trigeminal nerve. They are responsible for carrying the sensations of pain and touch to the brain from areas of the face including, but not limited to, the mouth, nose and cheeks. When trigeminal neuralgia occurs, even a mild sensation (washing the face, eating a snack or a slight breeze touching the face, etc.) can cause intense pain. Individuals with trigeminal neuralgia often describe the pain as electric shock sensations. The condition is chronic, and the intensity and frequency of pain typically increase over time.

Types

Trigeminal neuralgia is classified into two types:

• Type 1 or “classic” type
  Type 1 presents as intense, brief, sudden, blazing facial pain lasting from a few seconds to several minutes. These episodes may occur in quick succession and are very painful.
• Type 2 or “atypical” type
  Type 2 presents as a persistent stinging, aching, burning soreness of relatively less intensity than type 1. An individual may experience both types of trigeminal neuralgia, sometimes simultaneously.

Diagnosis

The diagnosis of trigeminal neuralgia is mainly based on an individual’s medical history and an account of their symptoms combined with a physical examination. A health care provider will need to know several things relating to an individual’s pain:

• Type — Does it feel like an electric shock? Is it Abrupt? Is it short-lived?
• Location — Where is the facial pain felt?
• Triggers — What causes the pain? Smiling? Eating? Talking?

A doctor may perform or order the following tests to determine a diagnosis of trigeminal neuralgia:

• Neurological examination — During a neurological exam, a health care provider feels an individual’s face to identify the specific area where the pain is occurring. A neurological exam also helps determine the affected branches of the trigeminal nerve if an individual has the condition. The reflexes of the face during a neurological exam can help identify if an individual has trigeminal neuralgia or if another medical condition is causing their symptoms.
• MRI — An MRI may be done to help determine if a tumor is compressing a trigeminal nerve or if multiple sclerosis is responsible for trigeminal neuralgia. In some cases, a specific type of MRI called magnetic resonance angiogram (MRA), which involves injecting a dye into a blood vessel, is ordered to obtain a clear picture of the veins and arteries and to check blood flow.

A short course of medication may be prescribed to accurately diagnose trigeminal neuralgia. Antiseizure medication is sometimes used to determine if pain is reduced; this may indicate a diagnosis of “classic” trigeminal neuralgia. A reduction in pain from low doses of tricyclic antidepressants may indicate a diagnosis of “atypical” trigeminal neuralgia.