Symptoms of Trigeminal Neuralgia
Trigeminal neuralgia is characterized by sudden, unilateral, severe, brief, stabbing, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve, which has a profound effect on quality of life. 1
Key Clinical Features
Pain Characteristics
- Location: Unilateral pain affecting the trigeminal nerve distribution, most commonly the second and third divisions, involving both extraoral and intraoral areas 1
- Quality: Sharp, shooting, electric shock-like, frightful pain; some patients may experience aching or burning after-pain 1, 2
- Duration: Paroxysmal attacks lasting from 2 seconds to minutes with a refractory period between attacks 1
- Severity: Moderate to very severe pain that significantly impacts daily functioning 1, 3
Triggers and Precipitating Factors
- Light touch to the face 1
- Washing the face 1
- Exposure to cold wind 1
- Eating or chewing 1
- Brushing teeth 1
- Talking 3
- Shaving 3
Associated Features
- Fear and depression, especially in cases of severe pain 1
- Facial spasms may occur during intense flare-ups 2
- Trigger zones - small areas where minimal stimulation precipitates a painful episode 2
- Patients may have normal examination findings between painful episodes 2
- Rarely, sensory changes in the affected area 1
Clinical Variants
Classical Trigeminal Neuralgia
- Most commonly caused by neurovascular compression of the trigeminal nerve at the root entry zone 1
- Typically presents with the characteristic paroxysmal pain with pain-free intervals 1
Trigeminal Neuralgia Type 2
- Features more prolonged pain between the sharp shooting attacks 1
- May have a more central origin rather than neurovascular compression 1
Secondary Trigeminal Neuralgia
- Symptomatic of other conditions such as tumors (mostly benign) or multiple sclerosis 1, 2
- May present with additional neurological symptoms depending on the underlying cause 1
Disease Course
- Characterized by exacerbations and remissions 4
- As the disorder progresses, remissions typically become shorter and exacerbations more severe 4
- Although rare, approximately 1% of patients may eventually develop bilateral symptoms, though pain does not cross the midline during any single episode 4
Diagnostic Considerations
- Diagnosis is made primarily on history alone, with careful attention to eliciting key features 5
- MRI imaging, including high-resolution trigeminal sequences, should be performed to rule out secondary causes and evaluate for neurovascular conflict 6, 2
- Important to differentiate from toothache or trigeminal autonomic cephalalgias 5