What Can Be Mistaken For Trigeminal Neuralgia?

Trigeminal neuralgia, a type of headache disorder, is often confused with other types of headache disorders and pain types. These include migraines, dental pain, sinusitis, and temporomandibular joint disorder. Getting a correct diagnosis is crucial, as this will determine the appropriate treatment. In this blog post, we will explore which diseases are commonly mistaken for trigeminal neuralgia.
Klara Hatinova

Klara Hatinova

Klara is postgraduate researcher in experimental psychology at the
University of Oxford.

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Conditions mistaken for trigeminal neuralgia

Painful conditions of the face or underlying neurological problems can often be mistaken for trigeminal neuralgia.

What is Trigeminal Neuralgia?

Trigeminal neuralgia is a painful neurological disorder that affects one or more divisions of the trigeminal nerve, which carries sensory information from the face and head [1].

Trigeminal neuralgia is characterized by sudden, usually unilateral, intense, short-lasting stabbing pain along the trigeminal nerve, the fifth cranial nerve [2]. Neuralgia attacks can be triggered by subtle stimulation, such as brushing the face, shaving or eating [1]. Although the pain only lasts 1-2 minutes, neuralgia has a profound impact on the quality of life of patients and can increase depression and anxiety in these individuals.

Did you know?

Trigeminal neuralgia is twice as common in women than in men, yet until 2016, researchers only used male models of neuralgia for research!

Causes of Trigeminal Neuralgia

Trigeminal neuralgia is a type of neuropathic pain caused by damage or compression to the trigeminal nerve that carries sensory information to the face and neck. There are multiple causes of damage or compression to the nerve:

  • One of the leading theories is the trigeminal nerve compression by a blood vessel in the section where it leaves the brainstem at the base of the head [1].
  • Other causes include traumatic compression of the nerve by neoplastic or vascular anomalies, infection, and intracranial tumours or conditions that impair nerve myelination such as multiple sclerosis [3].

What Can Be Mistaken For Trigeminal Neuralgia?

Sharp, intense, stabbing pain, a core signature of trigeminal neuralgia, is not specific to it. Conversely, many types of pain can be identified as misdiagnosed trigeminal neuralgia, conditions that can manifest similarly to trigeminal neuralgia.

  • Dental pain: Trigeminal neuralgia can be mistaken for pain of dental origin by both the patient and the dentist, leading to unnecessary dental procedures or tooth extractions [4, 5].
  • Temporomandibular dysfunction is a condition characterised by painful movement of the jaw. It is generally linked to pain in the joint or muscle rather than the nerve, which is specific to trigeminal neuralgia [6].

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Trigeminal neuralgia is diagnosed based on a combination of clinical evaluation and diagnostic tests. There is no single test that can definitively diagnose trigeminal neuralgia. The diagnosis is typically made by a healthcare professional, such as a neurologist, who will evaluate the patient's medical history, perform a physical examination, and assess the location and characteristics of the pain. Diagnostic tests, such as magnetic resonance imaging (MRI), may be ordered to rule out other conditions and identify any underlying causes or neurovascular compression. These tests can help confirm the diagnosis and guide treatment decisions. [1] [2]

The treatments for temporomandibular dysfunction (TMD) include noninvasive pharmacologic therapies, minimally invasive injections, physical therapy modalities, manual therapy, counseling, splint therapy, and surgical interventions. Noninvasive treatments may include medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and antidepressants. Minimally invasive injections may include botulinum toxin, corticosteroids, and hyaluronic acid. Physical therapy modalities, manual therapy, counseling, and splint therapy have shown effectiveness in reducing pain and improving function. Surgical interventions are considered when conservative treatments fail. [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]

  • Periodontitis. Although inflammation and observable gum reddening are prominent in periodontitis, there have been reports where inflammation of the gums was mistaken for trigeminal neuralgia. On the other hand, inflammation of the gums may indicate overall high inflammation, which could aggravate the trigeminal nerve and cause trigeminal neuralgia.
  • Tumours or Cancer. This condition is tricky because compression of the trigeminal nerve by tumours is a cause of trigeminal neuralgia [1, 7]. Nonetheless, recognising that trigeminal neuralgia can also indicate a more serious disorder requiring immediate medical attention. Other intracranial lesions or vessel ruptures can also present with symptoms similar to trigeminal neuralgia [8].
  • Multiple sclerosis and other neuralgias of the head and neck can also present symptoms like trigeminal neuralgia [9].
  • Occipital neuralgia. Occipital neuralgia is a headache disorder that occurs predominantly at the back of the head. This is in contrast to trigeminal neuralgia, which commonly occurs in the sides and facial regions of the head.
  • Atypical Facial Pain (AFP) is characterized by a dull, unrelenting pain that is ill-defined and, unlike trigeminal neuralgia, not triggered by facial movement or touch. Nonetheless, AFP can co-occur with trigeminal neuralgia. In an older study, 42% of patients diagnosed with trigeminal neuralgia also had AFP [5].
  • Neuritic type leprosy can also present with symptoms similar to trigeminal neuralgia. In a study, two out of three patients initially presented with neuralgic symptoms similar to trigeminal neuralgia and later developed borderline lesions on the face [9].

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The common symptoms of atypical facial pain include continuous or intermittent pain in one half of the face, often described as burning or lancinating. The pain may be dull or unrelenting and may fluctuate in intensity. It is typically not associated with specific triggers or relieved by typical pain medications. Other symptoms may include dys- or paraesthesias (abnormal sensations) in the face. Psychopathological abnormalities and neurotic problems are often present alongside the pain. [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]

Atypical facial pain (AFP) and trigeminal neuralgia (TN) are both types of facial pain, but they have distinct characteristics. AFP is a chronic and diffuse facial pain that does not have a clear cause or specific distribution. It is diagnosed by excluding other known causes of facial pain. In contrast, TN is characterized by paroxysms of severe, sharp, and electric shock-like pain in specific areas of the face along the trigeminal nerve. TN has a well-defined anatomical distribution and is often triggered by certain activities or stimuli. The treatment approaches for AFP and TN may also differ. [1], [2]

Summary: What Can Be Mistaken For Trigeminal Neuralgia?

In summary, the defining symptom of trigeminal neuralgia is short, stabbing, and unilateral pain. Several pain conditions around the face and head can be mistaken for trigeminal neuralgia. Therefore, it is important to seek medical diagnosis and get optimal treatment for what is causing your pain.

Klara Hatinova

Klara Hatinova

Klara is a postgraduate researcher in experimental psychology at the University of Oxford. She has worked across a spectrum of hot topics in neuroscience, including her current project measuring reinforcement learning strategies in Parkinson’s disease. Previously, she studied the efficacy of psilocybin as a therapy for critical mental health conditions and examined molecular circadian rhythms of migraine disorders. She completed her undergraduate degree in Neuroscience at the University of Glasgow and participated in a year abroad at the University of California, where she worked on a clinical trial for spinal cord injury.