Trigeminal Neuralgia

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Diagnosing and Treating Trigeminal Neuralgia

Trigeminal neuralgia is generally diagnosed with a combination of physical examination and evaluation of symptoms, but it’s a diagnosis by exclusion — if a patient (especially a woman over 50) complains of the classic symptoms of trigeminal neuralgia and other possible conditions can be ruled out, a doctor will probably diagnose TN and refer the patient to a neurologist, neurosurgeon, or pain management specialist. A patient under 40 with the same symptoms may be tested for multiple sclerosis.

In most cases, a neurological exam is normal except for the patient’s history of facial pain. In some cases, the doctor will order blood work to rule out conditions such as lupus or scleroderma, or a CT or MRI scan to look for a tumor or arteriovenous malformation (AVM).  These scans may reveal abnormal or elongated blood vessels that provide clues to the source of the pain. For the most part, however, trigeminal neuralgia can be diagnosed on the basis of the symptoms alone.

Since the goal is pain relief, TN treatment usually begins with medications known to be effective against nerve pain, including anti-spasmodic,  anti-epileptic (anticonvulsant), and tricyclic anti-depressant drugs, since these quiet down hyperactive nerves and dull pain signals from the trigeminal nerve. Patients sometimes try complementary and alternative medicine (CAM) approaches, either alone or in conjunction with prescription medications. CAM treatments include acupuncture, acupressure, vitamin therapy, and electrical stimulation of the nerves.

For some patients these treatments are insufficient, or they become ineffective over time. Those patients may consider surgical options for trigeminal neuralgia, including microvascular decompression, stereotactic radiosurgery, deep brain stimulation, or rhizotomy. (Find out more about Surgery for Trigeminal Neuralgia.)

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Reviewed by: Jared Knopman, M.D.
Last reviewed/last updated: October 2019