Clinical features and diagnostic pathways of trigeminal neuralgia: a retrospective study in a tertiary orofacial pain clinic

Background: Trigeminal neuralgia (TN) is a neuropathic facial pain disorder that frequently mimics odontogenic and other orofacial pain conditions, leading many patients to initially seek dental care. This study aimed to characterize the clinical features and diagnostic pathways of patients with TN presenting to a tertiary orofacial pain clinic. Methods: This single-center retrospective study included newly diagnosed patients with TN who attended a tertiary orofacial pain clinic between 2024 and 2025. Data regarding their demographic characteristics, pain features, pain intensity, trigger factors, and trigeminal nerve distribution were collected, and their psychological characteristics were assessed using the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7), and the 10-item Perceived Stress Scale (PSS-10). Diagnostic pathways before referral, including dental procedures performed before diagnosis, were also evaluated. Results: A total of 36 patients were assessed (mean age 66.8 ± 10.7 years; 66.7% female), and most presented with severe paroxysmal electric shock-like pain, predominantly involving the maxillary and mandibular divisions of the trigeminal nerve. Pain episodes were found to be triggered by light facial touch, with additional common triggers including washing the face, tooth brushing, speaking, and chewing. Pain intensity at presentation was graded as severe, with a mean Numerical Rating Scale (NRS) score of 8.17 ± 1.08. Moderate to moderately severe depressive symptoms, moderate to severe anxiety, and moderate perceived stress were frequently observed. Notably, before referral, 22.2% of patients had undergone tooth extraction, and 2.8%had received root canal treatment without achieving pain relief. Conclusions: Patients with TN presenting to a tertiary orofacial pain clinic exhibit characteristic neuropathic pain features, although their diagnostic pathways are variable, and a notable proportion undergo dental procedures before a confirmed diagnosis. Better recognition of these characteristic neuropathic pain features may facilitate earlier suspicion of TN, promote timely referral, and reduce unnecessary dental procedures.

Trigeminal neuralgia; Orofacial pain; Neuropathic pain; Clinical features; Diagnostic pathways; Retrospective study

[1] Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018; 38: 1–211.

[2] Maarbjerg S, Benoliel R. The changing face of trigeminal neuralgia—a narrative review. Headache. 2021; 61: 817–837.

[3] Cruccu G, Di Stefano G, Truini A. Trigeminal neuralgia. The New England Journal of Medicine. 2020; 383: 754–762.

[4] Snel BJ, Cohen SP, Erdine S, Day MR, Van Zundert J, Vissers K, et al. 13. Trigeminal neuralgia. Pain Practice. 2025; 25: e70051.

[5] Maarbjerg S, Di Stefano G, Bendtsen L, Cruccu G. Trigeminal neuralgia—diagnosis and treatment. Cephalalgia. 2017; 37: 648–657.

[6] Liu Y, Tanaka E. Pathogenesis, diagnosis, and management of trigeminal neuralgia: a narrative review. Journal of Clinical Medicine. 2025; 14: 528.

[7] Bendtsen L, Zakrzewska JM, Heinskou TB, Hodaie M, Leal PRL, Nurmikko T, et al. Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. The Lancet Neurology. 2020; 19: 784–796.

[8] Zakrzewska JM, Wu J, Mon-Williams M, Phillips N, Pavitt SH. Evaluating the impact of trigeminal neuralgia. Pain. 2017; 158: 1166–1174.

[9] Hilgenberg-Sydney PB, Calles BM, Conti PCR. Quality of life in chronic trigeminal neuralgia patients. Revista Dor. 2015; 16: 195–197.

[10] Allam AK, Sharma H, Larkin MB, Viswanathan A. Trigeminal neuralgia: diagnosis and treatment. Neurologic Clinics. 2023; 41: 107–121.

[11] Antonaci F, Arceri S, Rakusa M, Mitsikostas DD, Milanov I, Todorov V, et al.; Headache and Pain Scientific Panels of the European Academy of Neurology (EAN). Pitfals in recognition and management of trigeminal neuralgia. The Journal of Headache and Pain. 2020; 21: 82.

[12] International Classification of Orofacial Pain, 1st edition (ICOP). Cephalalgia. 2020; 40: 129–221.

[13] Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. Journal of General Internal Medicine. 2001; 16: 606–613.

[14] Lotrakul M, Sumrithe S, Saipanish R. Reliability and validity of the Thai version of the PHQ-9. BMC Psychiatry. 2008; 8: 46.

[15] Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine. 2006; 166: 1092–1097.

[16] Musumari PM, Tangmunkongvorakul A, Srithanaviboonchai K, Techasrivichien T, Suguimoto SP, Ono-Kihara M, et al. Grit is associated with lower level of depression and anxiety among university students in Chiang Mai, Thailand: a cross-sectional study. PLOS ONE. 2018; 13: e0209121.

[17] Cohen S, Williamson G. Perceived stress in a probability sample of the United States. In Spacapan S, Oskamp S (eds.) The social psychology of health: Claremont symposium on applied social psychology (pp. 31–67). Sage: Newbury Park, CA. 1988.

[18] Wongpakaran N, Wongpakaran T. The Thai version of the PSS-10: an investigation of its psychometric properties. BioPsychoSocial Medicine. 2010; 4: 6.

[19] Jeong YD, Jo Y, Son Y, Kim DK, Kim TH, Cho J, et al. Global incidence and prevalence of trigeminal neuralgia, 1945–2024: a systematic review and meta-regression analysis. Journal of Clinical Neurology. 2026; 22: 102–112.

[20] De Stefano G, Litewczuk D, Mollica C, Di Pietro G, Galosi E, Leone C, et al. Sex differences in trigeminal neuralgia: a focus on radiological and clinical characteristics. Neurological Sciences. 2023; 44: 4465–4472.

[21] Zakrzewska JM, Linskey ME. Trigeminal neuralgia. The BMJ. 2014; 348: g474.

[22] Haviv Y, Khan J, Zini A, Almoznino G, Sharav Y, Benoliel R. Trigeminal neuralgia (part I): revisiting the clinical phenotype. Cephalalgia. 2016; 36: 730–746.

[23] Labanca M, Gianò M, Franco C, Rezzani R. Orofacial pain and dentistry management: guidelines for a more comprehensive evidence-based approach. Diagnostics. 2023; 13: 2854.

[24] Martinelli R, Vannuccini S, Burattini B, D’Alessandris QG, D’Ercole M, Izzo A, et al. Psychological assessment in patients affected by trigeminal neuralgia. A systematic review. Neurosurgical Review. 2025; 48: 414.

[25] Pashkov A, Filimonova E, Martirosyan A, Moisak G, Rzaev J. Cognitive and personality profiles of patients with chronic trigeminal neuralgia. European Journal of Pain. 2025; 29: e70054.

[26] Hassan AF, Al Sheakh A, Badran SA, Mahmood AA, Alhamdani FY. Misdiagnosis-driven dental extractions in patients with trigeminal neuralgia: a retrospective study. Journal of Multidisciplinary Healthcare. 2025; 18: 1999–2005.

[27] Tripathi M, Sadashiva N, Gupta A, Jani P, Pulickal SJ, Deora H, et al. Please spare my teeth! Dental procedures and trigeminal neuralgia. Surgical Neurology International. 2020; 11: 455.

[28] Werner C, Harden J, Lawton J. Pathways to a diagnosis of trigeminal neuralgia: a qualitative study of patients’ experiences. BMC Primary Care. 2025; 26: 65.

[29] Tuncer Z, Akbulut N, Ozturk V, Beyaz SG. Knowledge and experience of dentists with patients with trigeminal neuralgia: a prospective, cross-sectional survey study. CRANIO®. 2024; 42: 84–89.