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How is Facial Pain Diagnosed?

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Symptoms

Neuropathic facial pain is diagnosed almost exclusively by the individual’s description of the symptoms. Your doctor will diagnose trigeminal neuralgia mainly based on your description of the pain, including:

  • Type. Pain related to trigeminal neuralgia is sudden, shock-like and brief.
  • Location. The parts of your face that are affected by pain will tell your doctor if the trigeminal nerve is involved.
  • Triggers. Trigeminal neuralgia-related pain usually is brought on by light stimulation of your cheeks, such as from eating, talking or even encountering a cool breeze.

Dr. Kim Burchiel developed a list of questions to help doctors determine exactly which classification may describe a patient’s pain. You may want to complete the Burchiel Questionnaire for your physician as a way of helping to determine the correct pain classification. This questionnaire in the hands of experienced neurologists and neurosurgeons can be very powerful. VIEW QUESTIONNAIRE

Examination

Your doctor may conduct many tests to diagnose trigeminal neuralgia and determine underlying causes for your condition, including a neurological examination. Touching and examining parts of your face can help your doctor determine exactly where the pain is occurring and which branches of the trigeminal nerve may be affected. Reflex tests also can help your doctor determine if your symptoms are caused by a compressed nerve or another condition.

Imaging

Doctors typically order an MRI scan when TN is suspected, in order to rule out multiple sclerosis or a tumor and look for an offending vessel that might be causing the pain. Special MRIs, known as high-resolution, thin-slice or three-dimensional (3D), have demonstrated the ability to predict fine trigeminal neurovascular compression. Newer more finite scans might show an artery pressing on the nerve, but not always a vein. Moreover, some images can be used to determine the “degree” of compression.

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