Trigeminal neuralgia laboratory findings

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Laboratory studies generally are not helpful in patients with typical symptoms of trigeminal neuralgia. Patients with characteristic history and normal neurologic examination may be treated without further workup. Occasionally, TMJ or dental radiographs may be useful when TMJ syndrome or dental pain is in the differential diagnosis.

Magnetic resonance imaging (MRI) or CT scan of the brain is useful to look for multiple sclerosis, tumors like acoustic neuromas, cerebellopontine angle tumors and many other causes of secondary trigeminal neuralgia. High resolution MRI or Magnetic resonance angiography(MRA) can be used to identify the neurovascular compression as a cause of classical trigeminal neuralgia as shown in image.

Diagnostic Criteria

 The International Classification of Headache Disorders, Third Edition (ICHD-3) diagnostic criteria for TN are as follows:

• A) Recurrent paroxysms of unilateral facial pain in the distribution(s) of one or more divisions of the trigeminal nerve, with no radiation beyond, and fulfilling criteria B and C

• B) Pain has all of the following characteristics:
  • Lasting from a fraction of a second to two minutes
  • Severe intensity
  • Electric shock-like, shooting, stabbing or sharp in quality

• C) Precipitated by innocuous stimuli within the affected trigeminal distribution

• D) Not better accounted for by another ICHD-3 diagnosis

The ICHD-3 further defines several subtypes of TN :

1. Classic (or classical) TN, caused by neurovascular compression.
2. Secondary TN, defined as TN caused by an underlying disease. Recognized causes include multiple sclerosis, cerebellopontine angle tumor, and arteriovenous malformation.
3. Idiopathic TN, defined as TN with neither electrophysiological tests nor MRI showing significant abnormalities.