How is trigeminal neuralgia diagnosed?

Written by Chen Yu Fei
Neurosurgery
Updated on April 17, 2025
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The diagnosis of trigeminal neuralgia is mainly based on the patient's clinical symptoms. It is mostly characterized by transient pain around the bilateral nasal root and corners of the mouth. There are generally no obvious prodromal symptoms before an attack; the pain occurs suddenly and stops suddenly. The nature of the pain is quite sharp, resembling knife-like cuts or a burning stabbing sensation. There are generally no significant signs before an onset, and the duration of an attack varies, lasting from a few seconds to several seconds, and even up to one or two minutes. Most patients experience sudden attacks and sudden cessation. Additionally, recurrent attacks can lead to severe adverse symptoms in patients and may even cause psychosomatic illnesses.

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Trigeminal neuralgia?

Trigeminal neuralgia is not uncommon in clinical settings; pain can often occur due to compression by blood vessels or tumor tissues. In addition, infections that irritate the trigeminal nerve can also cause pain. Therefore, it is essential to make assessments based on the specific conditions. In clinical practice, the initial treatment for trigeminal neuralgia typically involves oral medications. If there is no significant improvement with oral medications, further comprehensive examinations are necessary. Treatment options may include sphenopalatine ganglion block technique, microvascular decompression surgery, and craniotomy tumor removal surgery, among other measures. Thus, for trigeminal neuralgia, there are various treatment options available that can potentially provide significant relief. (The use of medications should be under the guidance of a doctor)

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What are the symptoms of trigeminal neuralgia?

The clinical symptoms of trigeminal neuralgia are mainly characterized by severe, paroxysmal pain in the area of the face distributed by the trigeminal nerve, typically affecting one side. The pain can affect one, two, or all three branches of the trigeminal nerve. The pain is episodic, resembling cutting, electric shocks, and is sudden in onset and cessation, making it unbearable for the patient. In some patients, actions such as eating, washing the face, or brushing teeth can trigger the pain. Most patients have trigger points, commonly located near the nostrils, corners of the mouth, or upper lip.

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Trigeminal neuralgia pain level

The World Health Organization classifies pain into five levels. Level zero is no pain. Level one is mild pain that does not require medication. Level two is moderate pain that requires medication. Level three is severe pain that necessitates medication. Level four involves severe and intense pain, often accompanied by changes in vital signs such as blood pressure, pulse, and respiration. Trigeminal neuralgia is a type of severe pain that occurs repeatedly in the trigeminal nerve area. It is recognized globally as one of the most painful diseases, often referred to as the "world's greatest pain" and "the cancer that does not kill." Patients often live in a state of feeling better off dead, which indicates the extreme level of pain associated with this disease. The pain level for this condition is classified as level four, the highest level.

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How is trigeminal neuralgia treated?

After the onset of trigeminal neuralgia, medication is the first choice of treatment. If the effect of medication is poor, surgical treatment can be considered. There are two methods of surgical treatment. One is radiofrequency treatment, which physically destroys the trigeminal nerve but often relapses after surgery. The other method is microvascular decompression surgery of the trigeminal nerve under a microscope. This surgery requires craniotomy under general anesthesia. Under the microscope, the trigeminal nerve and the blood vessel pressing on it are identified, and then a special material is used to separate the two, so the blood vessel cannot irritate the trigeminal nerve, and thus, the pain is alleviated.

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What should I do if trigeminal neuralgia recurs?

After the recurrence of trigeminal neuralgia, oral medication can be considered as the initial treatment. If the effect of the medication is not clear, or the side effects are intolerable, then balloon compression or radiofrequency treatment can be considered. These two methods can be used repeatedly, but they also have a certain recurrence rate. If neither medication nor radiofrequency treatment achieves satisfactory results, then surgical treatment can be considered. Microvascular decompression surgery of the trigeminal nerve can be performed under a microscope, where the trigeminal nerve and the blood vessel compressing it are separated, which can fundamentally resolve trigeminal neuralgia. (Specific medications should be used under the guidance of a physician.)