From the Guidelines
Trigeminal neuralgia typically presents with no physical abnormalities on examination, with the diagnosis primarily based on the patient's characteristic history of paroxysmal, severe, electric shock-like pain in the distribution of one or more branches of the trigeminal nerve. The physical findings of trigeminal neuralgia are largely absent between attacks, with patients appearing normal and having no sensory deficits, motor weakness, or reflex abnormalities in the trigeminal nerve distribution 1.
Key Physical Findings
- Trigger zones—areas that when touched provoke pain—may be identified on the face, particularly around the nasolabial fold, lips, or chin.
- During an acute attack, patients may grimace, wince, or protect their face from stimulation.
- Some patients might demonstrate subtle sensory changes on detailed examination, which could suggest secondary trigeminal neuralgia due to underlying pathology like multiple sclerosis or tumors.
- Occasionally, patients may have evidence of previous herpes zoster infection in the trigeminal distribution.
Importance of Clinical History
The absence of physical findings in the presence of severe pain is actually a hallmark of classic trigeminal neuralgia and helps distinguish it from other facial pain syndromes 1. A thorough clinical history is essential for diagnosing trigeminal neuralgia, as the condition is characterized by its unique pain profile and distribution.
Diagnostic Considerations
Advanced imaging techniques, such as MRI, can be useful in evaluating the trigeminal nerve and identifying potential causes of compression or other underlying pathologies 1. However, the diagnosis of trigeminal neuralgia remains primarily clinical, relying on the patient's history and physical examination findings.
From the Research
Physical Findings of Trigeminal Neuralgia
The physical findings of trigeminal neuralgia include:
- Sudden, severe, brief, and stabbing recurrent episodes of facial pain in one or more branches of the trigeminal nerve 2, 3, 4, 5, 6
- Pain attacks can occur spontaneously or can be triggered by non-noxious stimuli, such as talking, eating, washing the face, brushing teeth, shaving, a light touch or even a cool breeze 3, 4, 5, 6
- Facial spasms may occur during intense flare-ups 3
- Trigger zones are small areas where minimal stimulation may precipitate a painful flare-up 3
- Examination findings typically are normal between painful episodes 3
Diagnostic Criteria
The diagnosis of trigeminal neuralgia is based on:
- International Headache Society clinical criteria distinguishing classic, secondary, and idiopathic TN 3
- Brain magnetic resonance imaging with and without contrast media is recommended for all patients with suspected TN to rule out key differential diagnoses, such as a tumor, and to determine surgical candidacy 2, 3
Clinical Characteristics
The clinical characteristics of trigeminal neuralgia include: