Sudden, stabbing facial pain can feel like an electric shock, and it’s often terrifying. Many people assume it’s trigeminal neuralgia (TN), a chronic nerve condition. But here’s the problem: TN isn’t the only cause of this type of pain. In fact, several other conditions closely mimic its symptoms, making diagnosis tricky and, at times, misleading.
If you’ve been asking, “What Can Be Mistaken for Trigeminal Neuralgia?” you’re not alone. This article breaks down the key conditions that can be mistaken for trigeminal neuralgia, how to tell them apart, and why an accurate diagnosis is crucial to finally getting relief.
What Is Trigeminal Neuralgia?
Trigeminal neuralgia (TN) is a chronic pain disorder that affects the trigeminal nerve, the major sensory nerve of the face, branching into the forehead, cheek, and jaw (V1, V2, V3), which is responsible for carrying sensation from the face directly to the brain. It is marked by severe, intense, and electric shock-like pain in the face that typically affects one facial side and lasts for a few seconds to many minutes, and may come and go unpredictably.
Common Triggers:
Causes of Trigeminal Neuralgia
-
Compression of the trigeminal nerve, frequently by a surrounding blood vessel.
-
Multiple sclerosis (MS), an autoimmune condition that is characterized by damage to the myelin sheath present around nerves.
-
Tumors that are pressing on the trigeminal nerve.
-
Facial trauma or sometimes nerve injury.
Symptoms of Trigeminal Neuralgia
-
Sudden, sharp, stabbing or electric shock-like pain
-
Pain focused on the jaw, cheek, lips, gums, or around the eye
-
Typically affects only one side of the face
-
Pain triggered by touch, chewing, talking, or temperature changes
-
Episodes last seconds to minutes and come in waves
-
No visible swelling or signs of infection
What Can Be Mistaken for Trigeminal Neuralgia? 7 Conditions that Mimic TN
As trigeminal neuralgia shares similar symptoms with many other conditions, it can be misdiagnosed. So, understanding those conditions is important for proper diagnosis and treatment.
The following are the conditions commonly confused with trigeminal neuralgia:
1. Dental Problems
Why it’s confusing: Tooth pain often radiates across the jaw and face.
Dental issues such as toothaches, gum infections, and abscesses can cause pain in the teeth, gums, and jaw, which can lead to sharp and throbbing pain.
How does it differ from TN?
-
Dental pain is dull, throbbing, or constant, while TN pain is sudden, sharp, and shock-like.
-
Dental pain worsens with chewing or pressure on the tooth, and TN pain can be triggered even by a light touch.
Diagnosis Tip: If dental treatments (like fillings or extractions) don’t relieve pain, it may not be a tooth problem; it could be TN. Also, if the pain worsens when chewing or you see swelling or decay, it’s likely dental, not nerve-related.
2. Temporomandibular Joint Disorders (TMJ)
As the trigeminal nerve passes near the TMJ, TMJ disorders can irritate this nerve, causing facial pain that imitates trigeminal neuralgia, which also causes pain in the face.
How does it differ from TN?
-
TMJ disorder causes dull and aching pain in the face, jaw, and neck, while TN leads to severe, sharp, sudden, and shock-like facial pain.
-
Moreover, TMJ disorder becomes worse by chewing, grinding teeth, or jaw movement. On the other hand, TN worsens by chewing, a light touch, or a breeze.
Diagnosis tip: If chewing or yawning worsens the pain, suspect TMJ.
3. Cluster Headaches
Why it’s confusing: Both involve intense one-sided facial pain.
Both conditions impact the trigeminal nerve, which is responsible for carrying sensation from the face. Research shows that TN can induce cluster headaches by causing severe and throbbing pain on one side of the face.
How does it differ from TN?
-
Cluster headaches cause severe and intense pain around the eye, behind the eye, and on one side of the head, while TN pain is sharp, stabbing, and shooting, which is described as an electric shock.
-
Pain attacks from cluster headaches last for 15 minutes to 3 hours, and TN pain lasts for seconds to minutes, and in some cases, longer.
Diagnosis tip: Cluster headache pain is deeper and more pressure-like, while TN is sharper and electric.
4. Glossopharyngeal Neuralgia (GPN)
Why it’s confusing: Pain can radiate to the jaw, ear, and throat, overlapping TN zones.
Glossopharyngeal neuralgia and trigeminal neuralgia both cause debilitating pain in the face, making the people feel similar, according to a study.
How does it differ from TN?
-
GPN pain develops in the throat, ear, and tonsillar region, while TN pain is felt in the forehead, jaw, and cheek.
-
The triggering factors for GPN pain are chewing, coughing, swallowing, and drinking hot or cold beverages, and for TN pain include teeth brushing, washing the face, a light touch to the face, and even a breeze.
Diagnosis tip: If pain flares while swallowing or speaking, consider glossopharyngeal neuralgia.
5. Postherpetic Neuralgia (After Shingles)
Why it’s confusing: Both cause burning, stabbing facial pain.
Postherpetic neuralgia and trigeminal neuralgia impact the face and cause pain, which can cause confusion, especially due to the type of pain they cause.
How does it differ from TN?
-
PHN is typically a complication of shingles, while TN is caused by irritation or compression of the trigeminal nerve.
-
PHN pain is localized to the region where shingles rashes developed, that is, on the face or around the torso. TN pain is typically felt in the face, jaw, and forehead.
Diagnosis tip: A history of shingles is a strong clue. TN usually occurs without skin changes.
6. Sinus Infections (Sinusitis)
Why it’s confusing: Sinus pressure affects the same facial areas served by the trigeminal nerve.
Sinus infections often cause facial pain around the eyes, forehead, and cheeks, which are the areas served by the trigeminal nerve, leading to confusion.
How does it differ from TN?
-
Sinus infection pain is dull and aching that worsens with sudden head movement or bending, while TN pain is sharp and shooting, which is triggered by a light touch.
-
Sinus infections can cause facial pain, particularly around the cheeks, eyes, and forehead, which seems to be similar to the pain associated with TN.
Diagnosis tip: Sinus pain is pressure-like, not electric, and usually accompanied by nasal symptoms.
7. Myofascial Pain Dysfunction Syndrome (MDPS)
Why it’s confusing: Both MDPS and TN can cause facial pain, which can be persistent or irregular and triggered by eating, talking, or touching. Moreover, they often impact one side of the face.
How does it differ from TN?
-
MPDS pain is typically dull and aching, and is localized to muscles. TN pain is sharp, electric shock-like, and shooting, which is felt in the trigeminal nerve.
-
MPDS mostly impacts muscles and their surrounding part, while TN affects the trigeminal nerve only.
Diagnosis tip: MDPS pain is usually dull and spread out, not sudden and sharp.
A quick-reference table comparing TN with mimicking conditions:
|
Conditions
|
Pain Characteristics
|
Triggers
|
|---|---|---|
|
Trigeminal Neuralgia
|
Sharp, stabbing, electric shock-like, brief pain
|
Touch, eating, taking, and cold air
|
|
Dental Issues
|
Throbbing and constant pain
|
Biting and pressure from teeth
|
|
Temporomandibular Joint Disorder
|
Dull pain and pressure, which can radiate to other parts
|
Jaw movement and chewing
|
|
Postherpetic Neuralgia
|
Burning, stabbing, and persistent pain
|
Touch or light pressure
|
|
Cluster Headache
|
Deep, intense, and stabbing pain around the eye
|
Alcohol and disrupted sleep cycles
|
|
Sinusitis
|
Dull and aching pain along with a pressure-like sensation
|
Head movement and sinus pressure
|
|
Glossopharyngeal Neuralgia
|
Sharp, burning-like, and stabbing pain
|
Swallowing, talking, yawning, and coughing
|
|
Myofascial Pain Dysfunction Syndrome
|
Dull, aching, and persistent pain
|
Jaw movement, poor posture, grinding teeth, and stress
|
How to Know If It’s Trigeminal Neuralgia?
It is most likely trigeminal neuralgia if it causes:
-
Sudden and shock-like facial pain on one side
-
Pain is usually triggered by brushing teeth, talking, or a light touch
-
Pain increases and decreases, often suddenly and for a short period
-
No noticeable swelling or infection
-
Comes in episodes, with periods of severe pain that are followed by periods of no or less severe pain.
However, it might be some other issues, if pain:
Why is an Accurate Diagnosis Important?
You should know that misdiagnosis can lead to:
-
Inappropriate or delayed treatment
-
Negative affect on the quality of life
-
High risk of unnecessary surgeries or procedures
So, getting the accurate diagnosis helps:
-
Identify underlying issues that mimic trigeminal neuralgia, which include dental problems or temporomandibular joint disorders.
-
Ensure appropriate treatment, such as medicines or surgeries.
-
Prevent unnecessary procedures, like unneeded dental extractions, sinus surgeries, or root canals.
-
Reduce delay in getting the right treatment, which prevents long-term complications.
-
Improve the quality of life by helping people return to normal activities through receiving the proper treatment.
When to See a Specialist?
Consult a healthcare provider if you:
-
experience frequent facial pain that does not subside with OTC pain medications.
-
develop medicine-related side effects that become intolerable.
-
suspect the symptoms are caused by another reason.
Treatment Options for Trigeminal Neuralgia
If the doctors diagnose trigeminal neuralgia, they can help with these facial pain treatment options:
Medications:
-
Anticonvulsants: Includes carbamazepine and oxcarbazepine that block pain signals and relieve nerve pain.
-
Other Medications: Examples are baclofen (a muscle relaxant), tricyclic antidepressants, and Botox injections to reduce pain.
Surgical Options:
When medications do not show much response, the healthcare providers recommend the following surgical options:
|
Procedure
|
How it works
|
Best for
|
|---|---|---|
|
Microvascular Decompression (MVD)
|
Involves making a small incision (cut) behind the ear to remove or reposition the blood vessels that are causing pressure on the trigeminal nerve.
|
Classical trigeminal neuralgia, which occurs due to the compression of a trigeminal nerve by a blood vessel.
|
|
Stereotactic Radiosurgery (for example, Gamma Knife):
|
Uses low-dose beams of radiation that are targeted at the trigeminal nerve, which destroys abnormal tissue and helps reduce pain.
|
TN caused by tumors
|
|
Balloon Compression
|
Involves placing an empty balloon between the trigeminal nerve and the skull’s base, which, when inflated, presses the nerve, which damages the nerve and prevents the pain signals from travelling to the brain. This makes you feel no pain from light touches.
|
Pain impacting the first division of the trigeminal nerve
|
|
Glycerol Shots
|
Involves injecting a small amount of sterile glycerol into the trigeminal nerve, which damages the nerve fibers and interrupts pain signals, thus easing pain.
|
Idiopathic (with no known causes) pain or pain caused by multiple sclerosis
|
|
Neurectomy
|
Involves surgically cutting or removing the trigeminal nerve to reduce pain.
|
Recurrent pain after surgeries or pain not managed by medicines
|
Warning: Surgical options may lead to numbness or recurrence. If this is the case, seek medical attention again.
Other Approaches:
-
Lifestyle Changes: Identifying and avoiding potential triggers, such as chewing or sitting near an open window, and using a straw to sip hot or cold drinks. This can help reduce pain episodes.
-
Holistic Therapies: Acupuncture, meditation, yoga, chiropractic care, or biofeedback can also be helpful.
-
Exercises: Progressive muscle relaxation, gentle stretches, and facial muscle exercises can also bring some relief.
How to Prevent Trigeminal Neuralgia?
Living with Trigeminal Neuralgia can be stressful. Though it can’t be prevented, you can reduce the risk of pain attacks and manage other symptoms by following these tips:
1. Avoid Triggers
-
Identify and avoid triggers of pain, such as chewing, brushing teeth, consuming cold or hot foods and drinks, moving the head, and sitting in windy or cold weather.
2. Follow Good Oral Hygiene:
3. Manage Stress:
-
As stress worsens TN pain, practice meditation, deep breathing, and yoga to promote relaxation and reduce stress.
4. Follow a Healthy Lifestyle:
-
Eat a well-balanced diet, get enough sleep, and exercise regularly to minimize the likelihood of triggering pain.
5. Protect the Face:
6. Seek Early Treatment:
Final Thoughts
Not all facial pain is trigeminal neuralgia. Many conditions like dental problems, TMJ, and cluster headaches can look and feel similar, but they require very different treatments. Understanding what can be mistaken for trigeminal neuralgia is key to avoiding misdiagnosis and getting the right care.
If you’re experiencing sudden, intense facial pain, don’t self-diagnose. Consult a neurologist or pain specialist to get clarity and the right care. The sooner you get an accurate diagnosis, the sooner you can take back control of your life, pain-free.
