Diagnosing Trigeminal Neuralgia

Specialists at NYU Langone are experienced in diagnosing trigeminal neuralgia, a chronic pain condition that affects the trigeminal nerve, which is connected to the brain stem and is responsible for sensation in the face as well as certain motor functions, like chewing and biting. The condition is caused by compression of the trigeminal nerve at the brain stem, often due to an artery or vein pressing or rubbing against the nerve. This compression injures the nerve’s protective coating, causing irritation and pain. 

Symptoms of Trigeminal Neuralgia

Pain associated with trigeminal neuralgia is intense and can be both mentally and physically incapacitating. It’s most common around the side of the face or jaw, but you may also feel pain around the eyes or in the scalp, lips, forehead, and teeth. People with trigeminal neuralgia often describe this pain as being intermittent, sharp, and electric shock-like. Some people with trigeminal neuralgia may avoid social contact or withdraw from daily activities due to fear of an impending pain attack.

If you have trigeminal neuralgia, you may be pain-free for weeks or months between bouts of pain, or the pain may occur in intervals ranging from several hours to a few minutes or seconds apart. Many times, sensory stimuli—such as shaving, teeth brushing, or even smiling—can trigger the pain. 

The condition can happen to anyone but is more prevalent in women and people older than age 50. Trigeminal neuralgia can also occur in people with multiple sclerosis, a condition that causes deterioration of the trigeminal nerve’s protective coating. 

Diagnostic Tests

Arriving at a correct diagnosis of trigeminal neuralgia is often a complex process. Many times, the condition is misdiagnosed as dental or jaw pain, and a correct diagnosis can take years to obtain. NYU Langone’s team of neurologists and neurosurgeons diagnose trigeminal neuralgia based on a description of your symptoms, including the type of pain you are experiencing, its frequency and intensity, and where in the face this pain is located.

Because trigeminal neuralgia is sometimes caused by underlying medical conditions, your doctor may use the following to arrive at the most accurate diagnosis.

History and Neurological Exam

Your doctor takes a detailed medical history and asks about your symptoms before performing a neurological examination of the head and neck. A neurological examination may include an evaluation of your mental status, motor strength, vision, and reflex testing. Your doctor may also assess the nerves connected to the brainstem—the cranial nerves—by testing for sensation in the face, checking your hearing and eye movements, observing how you swallow, and watching your ability to move your head, neck, and shoulders.

A neurological exam can help your doctor determine if there is impairment of other nerves connected to the brain stem or if another condition, such as a tumor or multiple sclerosis, could be causing the pain. 

MRI Scan

Your doctor may order an MRI scan—in which magnetic waves and computers create two- or three-dimensional images—to better view the brain, head, and neck. This allows your doctor to identify the area where a blood vessel might be pressing against the nerve. This test can also help your doctor look for other conditions that can cause trigeminal neuralgia.

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