Diagnosis

As the pain caused by trigeminal neuralgia is often felt in the jaw, teeth or gums, many people with the conditioninitially visit their dentist rather than their GP.

Your dentist will ask you about your symptoms and investigate your facial pain using a dental X-ray . They'll look for other more common causes of facial pain, such as a dental infection or cracked tooth.

If your dentist can't find a cause, it's important not to undergo unnecessary treatment, such as a root canal filling or an extraction, even though you may be convinced that it's a tooth-related problem.

If your dentist can't find anything wrong, don't try to persuade them to remove a particular tooth as this won't solve the problem.

Trigeminal neuralgia is often diagnosed by a dentist, but if you've already seen your dentist and they haven't been able to find an obvious cause of your pain, you should visit your GP.

Seeing your GP

There's no specific test for trigeminal neuralgia, so a diagnosis is largely based on your symptoms and description of the pain.

If you've experienced attacks of facial pain, your GP will ask you questions about your symptoms, such as:

• how often the pain attacks occur
• how long the pain attacks last
• which areas of your face are affected

The more detail you can provide, the better.

Your GP will consider other possible causes of your pain and may also examine your head and jaw to identify which parts are painful.

Ruling out other conditions

An important part of the process of diagnosing trigeminal neuralgia involves ruling out other conditions that can also cause facial pain.

By asking about your symptoms and carrying out an examination, your GP may be able to rule out other conditions, such as:

• migraine
• joint pain in the lower jaw
• giant cell arteritis (temporal arteritis) where the medium and large arteries in the head and neck become inflamed and cause pain in the jaw and temples
• a possible nerve injury

Your medical, personal and family history will also need to be taken into consideration when determining possible causes of your pain.

For example, you're less likely to have trigeminal neuralgia if you're under 40 years old, and multiple sclerosis (MS) may be more likely if you have a family history of the condition or you have some other form of this condition.

However, trigeminal neuralgia is very unlikely to be the first symptom of MS.

MRI scans

If your GP isn't sure about your diagnosis or you have unusual symptoms, they may refer you for a magnetic resonance imaging (MRI) scan of your head.

An MRI scan uses strong magnetic fields and radio waves to create detailed images of the inside of your head.

It can help identify potential causes of your facial pain, such as inflammationof the liningof the sinuses (sinusitis) , tumours on one of the facial nerves, or nerve damage caused by MS.

An MRI scan may also be able to detect whether a blood vessel in your head is compressing one of the trigeminal nerves, which is one of the main causes of trigeminal neuralgia .