| Condition |
Defining symptoms of this condition |
How this condition differs from trigeminal neuralgia |
| Atypical facial pain |
Atypical face pain has no established diagnostic criteria. Pain is intense, deep, and persistent and may be difficult for the patient to localize. May be unilateral or bilateral. Considered to be rare |
Unrelenting pain. Does not generally follow trigeminal nerve distribution. May cause paresthesia, allodynia, tenderness, warmth, and numbness. No facial trigger points |
| Chronic paroxysmal hemicrania |
Chronic, unilateral headache with ipsilateral, cranial autonomic symptoms. Restlessness and agitation may occur. Present in the forehead or retrobulbar, lasting 2-45 minutes with prominent autonomic symptoms. Indomethacin is effective against pain |
Chronic pain, no abrupt-onset paroxysms. Does not generally follow trigeminal nerve distribution. Autonomic symptoms are prominent but may or may not occur in trigeminal neuralgia. Imaging studies may aid in diagnosis. Trigeminal neuralgia does not respond to indomethacin |
| Cluster headache |
Unilateral pain around the eye with sudden onset and paroxysms of potentially severe pain with restlessness. Sleep may exacerbate the condition. Rare condition, more prevalent in men than women |
While shooting pain occurs, there is a background of ambient pain; attacks last 20 minutes to hours. Autonomic symptoms and restlessness are hallmarks of cluster headache. Cluster headaches may show diurnal and seasonal rhythms. Cluster headaches may be relieved with high-flow oxygen gas, which will not benefit the trigeminal neuralgia patient. Suicidal ideation may occur with cluster headache attacks. Sleep exacerbates cluster headache; patients may wake up with a headache |
| Dental pain |
Dental pain does not occur in paroxysms but is more consistent; it is often dull and deep and is localized intraorally. Dental pain may be triggered by eating, chewing, or temperature. In some patients, dental extraction or other oral surgery precedes the development of true trigeminal neuralgia. Note that dental pain may occur independently of trigeminal neuralgia and complicate symptomatology. Autonomic symptoms do not occur with dental pain |
Pain localization may be helpful; dental pain occurs in the mouth around the tooth, while trigeminal neuralgia is in the face along the trigeminal dermatomes. Dental pain is usually preceded by a memorable event such as oral surgery, trauma, or other incident. Referral to a dentist may be appropriate |
| Giant cell arteritis |
Pain typically is localized in the forehead, neck, or temple. Pain is continuous, and there are no paroxysms or triggers. Pain is deep, dull, and continuous |
Pain does not follow the expected regions of the trigeminal nerve. No paroxysms and no obvious triggers. Pain is not sharp or stabbing |
| Migraine |
Unilateral, often intense pain. The patient may sense an oncoming attack; some migraineurs have “aura” preceding the headache. Triggers may include food (chocolate, red wine, and certain cheeses), bright lights, and loud noise. May align with the menstrual cycle. A complicating factor is that migraines may be comorbid with trigeminal neuralgia such that patients experience these two types of headaches as one disorder |
Trigeminal neuralgia is never associated with aura and has an abrupt onset. Migraine can occur with or without a trigger but does not occur with triggers such as chewing or light touch. Migraines can occur in pediatric patients and are common in younger patients than trigeminal neuralgia. Only migraines synch with menstrual cycles |
| Neuropathy of sensory fibers |
Numbness in the face may occur along the trigeminal distribution. Pain, if it occurs, is continuous and may be mild to severe. No paroxysmal pain |
No sudden-onset severe attacks of very brief pain, repeating over a period. Pain does not flare in multiple paroxysms. No triggers |
| Postherpetic neuralgia |
Present mostly in the forehead, around the eye, rarely along the cheek, and is characterized by continuous pain, although paroxysms of pain may also occur. Unilateral or bilateral. Pain is often mild to moderate and can vary over time. There may be sensory impairment around the affected area |
Pain likely does not follow trigeminal nerve distribution. Pain can be mild to severe, and variations can occur. Patient will have a history of shingles |
| SUNA, SUNCT |
Localized in or around the forehead, retrobulbar, with shooting paroxysms, five or many minutes. Prominent autonomic symptoms. Rare disorder and almost exclusively in women |
Trigeminal neuralgia does not have prominent autonomic symptoms. May present in the forehead |
| Temporomandibular disorders (TMD) |
Myalgia and headache can occur in the context of temporomandibular disorders; pain typically is localized in the jaw, temple, and ear. Pain is modified by jaw movements and can increase with the maximum unassisted opening of the mouth. Jaw motion may be limited. Pain is persistent and may be mild to severe. Pain may be present in the form of headache |
One of the most common forms of orofacial pain. Pain with temporomandibular disorders tends to be persistent, not triggered or paroxysmal. May be unilateral and overlap with trigeminal nerve distributions. Chronic TMD pain may be associated with fatigue, depression, and poor sleep |
