Symptoms are always confined to the trigeminal nerve distribution, with most cases involving the second or third division, or both. One study found that specific clinical variables may be helpful in determining the likely utility of MRI, which may be useful in prioritizing MRI studies when there is limited MRI capacity.One recent study demonstrated that trigeminal reflex testing could distinguish classical from symptomatic trigeminal neuralgia with a sensitivity of 96 percent and a specificity of 93 percent.Some disorders that might be included in the differential diagnosis of trigeminal neuralgia are listed in Longer-lasting pain; orbital or supraorbital; may cause patient to wake from sleep; autonomic symptomsDental pain (e.g., caries, cracked tooth, pulpitis)Localized; related to biting or hot or cold foods; visible abnormalities on oral examinationPersistent pain; temporal; often bilateral; jaw claudicationPain in tongue, mouth, or throat; brought on by swallowing, talking, or chewingLonger-lasting pain; associated with photophobia and phonophobia; family historyPain localized to ear; abnormalities on examination and tympanogramPain in forehead or eye; autonomic symptoms; responds to treatment with indomethacin (Indocin)Continuous pain; tingling; history of zoster; often first divisionPersistent pain; localized tenderness; jaw abnormalitiesLonger-lasting pain; orbital or supraorbital; may cause patient to wake from sleep; autonomic symptomsDental pain (e.g., caries, cracked tooth, pulpitis)Localized; related to biting or hot or cold foods; visible abnormalities on oral examinationPersistent pain; temporal; often bilateral; jaw claudicationPain in tongue, mouth, or throat; brought on by swallowing, talking, or chewingLonger-lasting pain; associated with photophobia and phonophobia; family historyPain localized to ear; abnormalities on examination and tympanogramPain in forehead or eye; autonomic symptoms; responds to treatment with indomethacin (Indocin)Continuous pain; tingling; history of zoster; often first divisionPersistent pain; localized tenderness; jaw abnormalitiesSymptomatic trigeminal neuralgia is usually caused by multiple sclerosis or by tumors arising near the trigeminal nerve root.
The trigeminal nerve is located on either side of the face just behind the ear. Oturai AB, Piovesan EJ, Eventually, if medication fails to relieve pain or produces intolerable side effects such as cognitive disturbances, memory loss, excess fatigue, bone marrow suppression, or allergy, then surgical treatment may be indicated. Special MRI imaging procedures can reveal the presence and severity of compression of the nerve by a blood vessel.A diagnosis of classic trigeminal neuralgia may be supported by an individual’s positive response to a short course of an antiseizure medication.
Some degree of facial numbness is expected after many of these procedures, and TN will often return even if the procedure is initially successful.
Diagnosis of TN2 is more complex and difficult, but tends to be supported by a positive response to low doses of tricyclic antidepressant medications (such as amitriptyline and nortriptyline), similar to other neuropathic pain diagnoses.Treatment options include medicines, surgery, and complementary approaches.Anticonvulsant medicines—used to block nerve firing—are generally effective in treating TN1 but often less effective in TN2. Booher SL, Learn about pain management tips such as strength training, biofeedback, and yoga, as well as forms of chronic pain such as lower back pain, arthritis, migraines, and more.Learn about nerve pain symptoms, causes, and treatment options.
Zakrzewska JM. TN is a form of neuropathic pain (pain associated with nerve injury or nerve lesion.) Other diagnoses must also be considered, particularly in patients with atypical features of the disease or “red flags” in the history or physical examination Because trigeminal neuralgia is a clinical diagnosis, the patient's history is critical in the evaluation. This scan may or may not clearly show a blood vessel compressing the nerve. Castelijns JA, Eriksen J, A randomized double-blind placebo-controlled trial. For many people, medications lose efficacy over time and increase in dosage comes with complications of the drug side effects.MedicineNet does not provide medical advice, diagnosis or treatment. These procedures involve posterior fossa exploration with its attendant risks, including stroke, meningitis, and death, although the reported incidence of these complications with microvascular decompression is less than 2 percent. Diagnostic accuracy of trigeminal reflex testing in trigeminal neuralgia. Trigeminal Neuralgia.
Haanpää M, Epstein JB,
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