What Can Be Mistaken for Trigeminal Neuralgia?

Trigeminal neuralgia causes sudden, severe, electric shock-like pain in the face. Because the pain is often felt in the teeth, jaw or cheek, many people see a dentist first, and several other conditions can cause facial pain that looks similar. Getting the right diagnosis matters, because the treatments are completely different.

This guide explains the classic features of trigeminal neuralgia, the conditions most often mistaken for it, and the warning signs that need urgent attention.

The classic features of trigeminal neuralgia

• Sudden, stabbing or electric shock-like pain lasting from a fraction of a second to about two minutes
• Usually on one side of the face, most often the cheek, jaw, teeth or gums
• Triggered by light touch, washing, shaving, eating, talking, brushing teeth or a cold breeze
• Little or no pain between attacks, often with pain-free periods lasting weeks or months

Pain that is constant, throbbing or dull, or that lasts for hours, points away from classic trigeminal neuralgia.

Dental causes

• Inflamed tooth nerve: throbbing or aching pain, often triggered by hot or cold and lingering after the stimulus is removed.
• Cracked tooth: sharp pain when biting, particularly when releasing the bite, usually from one tooth.
• Dental abscess: constant, throbbing pain with tenderness when the tooth is tapped, and sometimes swelling or fever.

A dentist can usually find a clear dental cause. If treatment does not help and the pain is brief and shock-like, ask your GP about trigeminal neuralgia before more dental work is done.

Jaw and sinus problems

• TMJ disorder: aching in front of the ear and in the jaw, worse with chewing, often with clicking and morning pain from clenching. The pain lasts longer than an attack of neuralgia.
• Sinusitis: pressure or aching across the cheeks and forehead, worse bending forwards, usually with a blocked or runny nose after a cold.

Headache disorders

• Cluster headache: severe pain around one eye lasting 15 minutes to three hours, with a red, watering eye and a runny nostril on the same side. Attacks often come at the same time each day and people feel restless rather than still.
• SUNCT and SUNA: rare headaches with very short attacks of stabbing pain around the eye, often with a red, watering eye. They can closely resemble trigeminal neuralgia affecting the forehead and are diagnosed by a specialist.
• Migraine: throbbing pain lasting hours, often with nausea and sensitivity to light and sound. It can occasionally be felt mainly in the face.

Other nerve pains

• Post-herpetic neuralgia: burning, constant pain and skin sensitivity in an area previously affected by shingles.
• Glossopharyngeal neuralgia: similar shock-like pain but in the throat, back of the tongue or ear, triggered by swallowing.
• Occipital neuralgia: shooting pain at the back of the head and scalp.
• Persistent idiopathic facial pain: a daily, dull, poorly localised ache in the face without a clear cause.

Conditions that need prompt or urgent attention

• Giant cell arteritis: in people over 50, a new headache, scalp tenderness, pain in the jaw when chewing or any change in vision needs same-day medical care, because it can threaten sight.
• Multiple sclerosis: trigeminal neuralgia in a younger person, on both sides, or with numbness should be assessed by a neurologist.
• Facial numbness, weakness, double vision or hearing loss alongside facial pain needs prompt assessment.
• Call 999 for facial drooping, slurred speech or weakness in an arm or leg.

How trigeminal neuralgia is diagnosed

Diagnosis is based mainly on your description of the pain. A GP may start treatment and refer you to a neurologist, who often arranges an MRI scan to look for a blood vessel pressing on the nerve or another cause. A good response to the usual first-line medicine can also support the diagnosis.

Bring a pain diary to your appointment

Note how long each attack lasts, exactly where it is felt, what triggers it, what it feels like and whether anything eases it. This helps your doctor tell trigeminal neuralgia apart from the conditions above.

Frequently asked questions

Can a tooth problem feel like trigeminal neuralgia?

Yes. Cracked teeth and inflamed tooth nerves can cause sharp facial pain. Dental pain is usually linked to one tooth and to biting or temperature, while trigeminal neuralgia is triggered by light touch and comes in brief shocks.

Can trigeminal neuralgia affect both sides of the face?

Rarely. Pain on both sides should be assessed by a neurologist.

Can stress cause trigeminal neuralgia?

Stress does not cause it, but many people find attacks are more frequent during stressful periods.

Who diagnoses trigeminal neuralgia?

Usually a GP makes the initial diagnosis, with referral to a neurologist for confirmation and a scan.

Support for trigeminal neuralgia in Chiswick

Omnia Lifestyle does not diagnose trigeminal neuralgia, but supports people alongside their GP or neurologist at our clinic in Chiswick, W4, close to Turnham Green station, on bus routes 94, E3 and 272. Limited parking is available on request when booking.

Read more about trigeminal neuralgia, TMJ and jaw pain, shingles nerve pain and headaches, explore acupuncture, or book an appointment.

This article is general information, not medical advice. If you have any of the warning signs listed above, seek medical attention.