Table 3. Points to consider in differential diagnosis of TN.

Differential diagnosis of TN [49]

MRI: magnetic resonance imaging; TMD: temporomandibular disorder; TN: trigeminal neuralgia; SUNA: short-lasting unilateral neuralgiform; SUNCT: short-lasting unilateral neuralgiform headache with conjunctival injection and tearing

Description	TN	Dental	TMD	Cluster	Migraine	SUNA/SUNCT	Paroxysmal hemicrania
Pain timing	Paroxysmal, short duration, and repeated	May be associated with recent dental work; pain can last a few months	Hours or continuous, may be episodic	Paroxysmal episodes of short duration that cluster for an attack that can persist for hours	Gradual onset may be preceded by aura; pain is continuous throughout the attack that can last hours	Paroxysms of short duration but severe pain that repeats; no continuous background pain	Episodic bursts of pain lasting 2-30 minutes may repeat multiple times a day
Remissions	Yes, maybe pain-free between paroxysms and often fully asymptomatic between attacks	Yes, will be persistent but resolve	Can persist for years	Yes, unexpected remissions occur	Yes, possible	Yes, unexpected remissions occur	Yes, unexpected remissions occur
Pain quality	“Electric,” shooting, stabbing pain in the face. Pain starts suddenly and at severe intensity. Background pain may or may not be present between paroxysms	Sharp pain, deep aching pain, and throbbing sensation	Mostly deep, dull pain, but may be sharp at times. Builds up gradually. Can be mild or severe, or can be chronic	Sharp stabbing pain around one eye, sudden onset, and severe intensity. Pain may remit entirely between episodes	Gradually building pain that can become severe in intensity; no paroxysms or flares of pain. Persistent over several hours	Sharp, stabbing, burning pain of severe intensity and short duration (five seconds to a few minutes) with remissions and repetitions	Deep pain, throbbing sensations, sometimes stabbing, or shooting pain. Pain is episodic (2-30 minutes) and can repeat many times over the course of a day
Pain location	Along trigeminal distribution (V2 and/or V3 mostly), but intraoral sometimes occurs. Frequently unilateral	Intraoral and localized around a tooth	Around the mandible but may radiate up (temple) or down (neck)	Typically unilateral, around one eye	May be unilateral or bilateral	Periorbital but may extend to the maxillary region	Periorbital that can extend to temple
Triggers	Light touch and innocuous triggers. Evoked pain is necessary for diagnosis	Hot, cold, and sweet applied to the tooth; eating may cause pain as well	Chewing, grinding teeth, yawning, and eating	Food triggers (red wine, chocolate), bright light, loud sounds, but triggers not necessary	Food triggers (red wine, chocolate), bright light, loud sounds, but triggers not necessary	Light touch	None known
Often confused with	Migraine or cluster	TMD	Dental	Paroxysmal hemicranias and TN	TN	TN, migraine	Migraine
Differential considerations	MRI studies may be useful. Abrupt onset	Patient history and dental referral	Pain location and oral involvement	Restlessness and agitation; autonomic symptoms	May be preceded by aura; nausea often occurs with an attack	Restlessness and agitation; marked autonomic symptoms	Autonomic symptoms. Indomethacin relieves it