OVERDIAGNOSIS OF TRIGEMINAL NEURALGIA IN OUTPATIENT PRACTICE: ISSUES OF DIFFERENTIAL DIAGNOSIS (Review Article)
Keywords:
trigeminal neuralgia; temporomandibular disorders; facial pain; differential diagnosis; outpatient neurologyAbstract
Background. Facial pain is a clinically heterogeneous syndrome in outpatient neurology. Trigeminal neuralgia is traditionally regarded as a clearly defined nosological entity; however, pain syndromes associated with temporomandibular joint dysfunction may closely mimic neuralgic pain and lead to diagnostic errors at the primary care level.
Objective. To identify clinical markers with the highest diagnostic value for differentiating trigeminal neuralgia from temporomandibular disorder–related pain in outpatient practice.
Methods. This expert clinical review is based on ICHD-3 and DC/TMD diagnostic criteria, European Academy of Neurology clinical guidelines, and key publications relevant to outpatient facial pain diagnostics, complemented by the author’s clinical experience.
Results. Pain characteristics, temporal structure, association with masticatory load, reproducibility on palpation, and response to therapy were identified as the most informative diagnostic features.
Conclusion. Systematic assessment of combined clinical markers reduces the risk of trigeminal neuralgia overdiagnosis and supports timely identification of temporomandibular disorder–related pain.
References
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (ICHD-3). Cephalalgia. 2018;38(1):1–211.
Cruccu G, Finnerup NB, Jensen TS, et al. Trigeminal neuralgia: new classification and diagnostic grading. Neurology. 2016;87(2):220–228.
Zakrzewska JM, Linskey ME. Trigeminal neuralgia. BMJ. 2014;348: g474.
Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). J Oral Facial Pain Headache. 2014;28(1):6–27.
De Leeuw R, Klasser GD. Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management. Quintessence Publishing; 2018.
Graff-Radford SB. Facial pain and temporomandibular disorders. Headache. 2014;54(9):1407–1414.
Bendtsen L, Zakrzewska JM, Abbott J, et al. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol. 2019;26(6):831–849.
Ballegaard V, Svensson P, Jensen R. Are temporomandibular disorders related to trigeminal neuralgia-like pain? Cephalalgia. 2008;28(8):832–841.
Табеева Г.Р. Лицевая боль: клиника, диагностика, лечение. Журнал неврологии и психиатрии им. С.С. Корсакова.
Орлова О.Р. Миофасциальные болевые синдромы лица и шеи. Журнал неврологии и психиатрии им. С.С. Корсакова. 2014.
Вейн А.М., Дюкова Г.М. Боль и болевые синдромы в неврологической практике. Москва: МЕДпресс-информ; 2011.
