TN Classifications

Classic Trigeminal Neuralgia, Type 1 (TN1)

Also known as “Tic Douloureux,” this consists of facial pain of spontaneous onset with greater than 50% limited to the duration of an episode of pain. Essentially, it’s random bursts of extreme facial pain. TN is often caused by loss of or damage to the nerve’s protective coating, (myelin). The most widely accepted view is that myelin damage results from irritation of the nerve, usually a blood vessel that causes the nerve to be compressed.

Trigeminal Neuralgia, Type 2 (TN2)

Categorized by facial pain of spontaneous onset with greater than 50% as a constant pain. As opposed to TN1, Type 2 is a more consistent pain that doesn’t just appear in bursts.

Trigeminal Neuropathic Pain (TNP)

Facial pain resulting from unintentional injury to the trigeminal system from facial trauma, oral surgery, ear, nose and throat (ENT) surgery, root injury from posterior fossa or skull base surgery, stroke, etc. This pain is described as dull, burning, or boring and is usually constant because the injured nerve spontaneously sends impulses to the brain. The injured nerve is also hypersensitive to stimulation, so attacks of sharp pain can also be present. The area which is sensitive to touch and triggers these sharp attacks is the same area where the pain occurs. Numbness and tingling are also signs of a damaged nerve.

Trigeminal Deafferentation Pain (TDP)

Facial pain in a region of trigeminal numbness resulting from intentional injury to the trigeminal system from neurectomy, gangliolsys, rhizotomy, nucleotomy, tractotomy, or other denervating procedures. Despite the loss of sensation, constant pain is felt in the numb area(s), which varies in intensity and can include sensations of burning, crawling, tingling, boring, stinging, and/or unpleasant aching.

Other Facial Pains:

Secondary Symptomatic Trigeminal Neuralgia (STN): Pain resulting from multiple sclerosis.

Post-Herpetic Neuralgia (PHN): Pain resulting from herpes zoster outbreak (Shingles) along the trigeminal nerve.

Diagnostic Questions

At OHSU's Department of Neurological Surgery they have developed a helpful questionnaire for the diagnosis and treatment of patients suffering from varies types of trigeminal neuralgia.   You can take this test online by clicking on this link or going to the Oregon Health & Science University website and searching for it there.  If you do go online, the computer can calculate which classification best matches your symptoms.

1 ) Do you have facial pain?

        YES     NO 

2 ) Do you remember exactly where you were the moment your facial pain started?

        YES     NO 

3 ) When you have pain, is it predominantly in your face (i.e., forehead, eye, cheek, nose, upper/lower jaw, teeth, lips, etc)?

        YES     NO 

4 ) Do you have pain just on one side of your face?

        YES     NO 

5 ) When you have pain, is it predominantly deep in your ear?

        YES     NO 

6 ) When you have pain, is it predominantly in the back of your throat or tongue, near the area of your tonsil?

        YES     NO 

7 ) Is your pain either entirely or mostly brief (seconds to minutes) and unpredictable sensations (electrical, shocking, stabbing, shooting)?

        YES     NO 

8 ) Do you have any constant background facial pain (e.g., aching, burning, throbbing, stinging)?

        YES     NO 

9 ) Do you have constant background facial pain (aching, burning, throbbing, stinging) for more than half of your waking hours?

        YES     NO 

10 ) Do you have any constant facial numbness?

        YES     NO 

11 ) Can your pain start by something touching your face (for example, by eating, washing your face, shaving, brushing teeth, wind)?

        YES     NO 

12 ) Since your pain began have you ever experienced periods of weeks, months, or years, when you were pain-free? (This would not include periods after any pain-relieving surgery or while you were on medications for your pain.)

        YES     NO 

13 ) Have you ever taken Tegretol ® (carbamazepine), Neurontin ® (gabapentin), Lioresal ® (baclofen), Treleptal ® (oxcarbazepine), Topamax ® (topiramate), Zonegran ® (zonisamide), or any other anticonvulsant medication for your pain?

        YES     NO 

14 ) Did you ever experience any major reduction in facial pain (partial or complete) from taking any of the medications listed in Question 13, or any anticonvulsant medication?

        YES     NO 

15 ) Have you ever had trigeminal nerve surgery for your pain? (e.g., neurectomy, RF rhizotomy/gangliolysis, glycerol injection, balloon compression, rhizotomy, MVD, gamma knife)

        YES     NO 

16 ) Have you ever experienced any major reduction in facial pain (partial or complete) from trigeminal nerve surgery for your pain? (e.g., neurectomy, RF rhizotomy/gangliolysis, glycerol injection, balloon compression, rhizotomy, MVD, gamma knife)

        YES     NO 

17 ) Did your current pain start only after trigeminal nerve surgery (neurectomy, RF rhizotomy/gangliolysis, glycerol injection, balloon compression, rhizotomy, MVD, gamma knife)? (If this is a recurrence of your original pain after a successful trigeminal nerve surgery, answer "no")

        YES     NO 

18 ) Did your pain start after facial zoster or"shingles" rash (Herpes zoster - not to be confused with "fever blisters" around the mouth)?

        YES     NO 

19 ) Do you have multiple sclerosis?

        YES     NO 

20 ) Did your pain start after a facial injury?

        YES     NO 

21 ) Did your pain start only after facial surgery (oral surgery, ENT surgery, plastic surgery)?

        YES     NO 

22 ) When you place your index finger right in front of your ears on both sides at once and feel your jaw open and close; is this where you predominantly feel pain?

        YES     NO