Trigeminal neuralgia has become a widely recognised diagnosis, but the truth is, it is often overdiagnosed. Many patients experiencing facial pain are told they have trigeminal neuralgia when the actual cause may be something else entirely. Getting the wrong diagnosis can mean months of ineffective treatment and unnecessary frustration. So let us break down what really causes facial pain, clear up some common myths and look at how to treat trigeminal neuralgia when it is the correct diagnosis.
Common Causes of Facial Pain
Facial pain can stem from a range of conditions, each requiring a different approach to management. At a specialist pain management clinic, these are the most commonly diagnosed causes.
- Temporomandibular disorders (TMD) are the most common cause of chronic facial pain, affecting up to 45% of patients. These disorders involve the muscles and jaw joint and are frequently mistaken for other conditions.
- Post-traumatic trigeminal neuropathy (PTTN) occurs when a facial pain condition stems from nerve damage due to injury, often following procedures such as molar tooth extraction.
- Trigeminal neuralgia (TN) is characterised by brief, electric shock-like episodes of pain. It remains rare, affecting only 0.16 – 0.3% of the population.
- Orofacial migraine causes pain primarily across the face, often accompanied by nausea and sensitivity to light or sound.
- Trigeminal autonomic cephalalgias are a rare group of conditions characterised by pain in a specific facial area, such as the eye, accompanied by symptoms like tearing or redness.
Common Myths About Facial Pain
Misconceptions around facial pain can lead to misdiagnosis and delayed treatment. Here are some of the most persistent myths.
- “Facial pain is usually trigeminal neuralgia.”In reality, TMD and PTTN are far more common than Trigeminal Neuralgia.
- “Any neuropathic facial pain is TN.” Facial pain caused by nerve injury is more likely to be PTTN, which requires a very different treatment approach.
- “TMJ pain means joint problems.” Most TMD pain originates in the surrounding muscles, not the joint itself.
- “Pain in the upper face is usually TN.” Trigeminal neuralgia rarely affects the upper face.
- “Facial pain cannot be migraine.” Migraines can present as facial pain, even without a typical headache.
- “TMJ clicking or popping will get worse.” Clicking from the jaw joint is often normal and does not always signal worsening of the condition.
- “Everyone with facial nerve pain needs a brain MRI.” Whether imaging is needed depends on your symptoms. For PTTN after a dental extraction, a brain MRI is rarely required.
Get the Right Diagnosis at a Specialist Pain Clinic
Correctly identifying the type of facial pain is essential because treatments vary significantly. Procedures such as microvascular decompression and Gasserian ganglion radiofrequency ablation can be highly effective for trigeminal neuralgia, but these same approaches may lead to poor outcomes for patients with PTTN. This is why how to prevent trigeminal neuralgia from worsening starts with getting the right diagnosis first.
If you experience chronic facial pain, do not wait for symptoms to progress. Early and accurate diagnosis can make all the difference in finding the right path to relief.Dr Christopher Liu is a pain specialist in Singapore at Alleviate Pain Clinic with a focus on headaches and orofacial pain. He provides trigeminal neuralgia treatment in Singapore alongside care for migraines, cervicogenic headaches and trigeminal autonomic cephalalgias through a range of minimally invasive interventions. Schedule an appointment today.
