Trigeminal neuralgia physical examination

Signs of trigeminal neuralgia can be seen in males who may deliberately miss an area of their face when shaving, in order to avoid triggering an episode. Although trigeminal neuralgia is not fatal, successive recurrences may be incapacitating, and the fear of provoking an attack may make sufferers reluctant to engage in normal activities.

The physical examination in patients with trigeminal neuralgia is generally normal. Therefore, physical examination in patients with facial pain is most useful for identifying abnormalities that point to other diagnoses. The physician should perform a careful examination of the head and neck, with an emphasis on the neurologic examination. The ears, mouth, teeth, and temporomandibular joint (TMJ) should be examined for problems that might cause facial pain.

The finding of typical trigger zones verifies the diagnosis of trigeminal neuralgia. Patients with classical trigeminal neuralgia have a normal neurologic examination. Sensory abnormalities in the trigeminal area, loss of corneal reflex, or evidence of any weakness in the facial muscles should prompt the physician to consider secondary trigeminal neuralgia or another cause of the patient’s symptoms.^[1]

Here are some atypical features in the physical examination that can point towards diagnosis other than trigeminal neuralgia:

• Abnormal neurological examination
• Abnormal oral, dental, or ear examination
• Age younger than 40 years
• Bilateral symptoms
• Dizziness or vertigo
• Hearing loss or abnormality
• Numbness
• Pain episodes persisting longer than two minutes
• Pain outside of trigeminal nerve distribution
• Visual changes

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