The Changing Face of Trigeminal Neuralgia

A Narrative Review

Stine Maarbjerg MD, PhD; Rafael Benoliel BDS (Hons)


Headache. 2021;61(6):817-837. 

In This Article

Differential Diagnosis of Trigeminal Neuralgia

The numbers of misdiagnosed TN cases suggest that the clinical presentation may not always be clear or typical, or there is a general lack of awareness of the features of TN in spite of TN having a typical and dramatic clinical presentation.

The diagnostic pitfall of suspecting TN in any facial pain patient merely because of an MRI-verified neurovascular contact is frequently observed in clinical practice. As previously stated, TN diagnosis is clinical and is based on clear diagnostic criteria. It is only if the diagnostic criteria for TN are fulfilled that it is of interest to look for a neurovascular contact.

Depending on location, the presence of background pain and other signs such as tearing, patients attend the most appropriate clinician in their own judgment. A recent survey found that most patients with TN consult medical professionals including primary care physicians (43.1%), dentists (in 30.4%), otorhinolaryngologists (3.9%), neurosurgeons (3.9%), and neurologists or headache specialists (14.7%).[94] The common misdiagnoses are surprising and include migraine (n = 5, 6.5%), cluster headache (n = 4, 5.2%), temporomandibular joint dysfunction (n = 3, 3.9%), tension-type headache (n = 1, 1.3%), glaucoma (n = 1, 1.3%), otitis (n = 1 1.3%), and tonsillitis (n = 1, 1.3%).[94,95]

The mean diagnostic delay from disease onset was 10.8 ± 21.2 months. Misdiagnoses at first consultation were found in 42.1% of the cases, whereas only 19 subjects (18.4%) received a correct diagnosis.[94] The number of TN cases presenting with extensive misdiagnosis suggests that there is a need to increase education and awareness among all medical professionals.