Trigeminal Neuralgia

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Diagnosis

Although a number of conditions can cause facial pain, the symptoms of trigeminal neuralgia are very specific. An initial diagnosis often can be made by taking a detailed medical history and performing a physical examination. A dental exam can help determine if the teeth or gums are causing the pain.

To confirm the diagnosis, other conditions that can cause facial pain (e.g., infection of the jaw or sinuses; fibromyalgia; migraine; Bell's palsy) and other types of nerve disorders (e.g., trigeminal neuropathy) must be ruled out. Trigeminal neuropathy causes weakness, numbness, and a loss of sensation, in addition to facial pain.

Diagnostic tests, such as computed tomography (CT) scan, magnetic resonance imaging (MRI) scan, or magnetic resonance angiography (MRA), also may be performed to help detect other conditions.

In CT scan, x-rays are taken from different angles and are used to create a cross-sectional image (called a tomogram) of structures in the body (e.g., brain, skull, sinuses). This test can be used to detect blood clots, tumors, and infections.

MRI scan uses electromagnetic radio waves to create detailed images of organs, tissues, and nerves. MRI can be used to detect strokes, aneurysms, and tumors.

Magnetic resonance angiography is a special type of magnetic resonance imaging scan that is used to produce images of blood vessels (e.g., veins, arteries). This test is used to detect blood vessel abnormalities and to evaluate blood flow.

Underlying conditions that can cause facial pain and that must be ruled out include the following:

• Cancer (e.g., lymphoma, throat cancer)
• Certain medications
• Guillain-Barre syndrome
• Infections (e.g., otitis media, mastoiditis)
• Injury (trauma)
• Meningitis
• Multiple sclerosis (MS)
• Sarcoidosis
• Stroke
• Tumors and other lesions (e.g., aneurysm, neurofibroma, neuroma)
• Viruses (e.g., herpes zoster)

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