Trigeminal neuralgia is diagnosed clinically, from brief episodes of severe electric shock-like facial pain in the trigeminal nerve distribution, triggered by light touch such as eating, talking or a breeze. MRI is arranged to look for a cause.
Trigeminal neuralgia is diagnosed clinically, from brief episodes of severe electric shock-like facial pain in the trigeminal nerve distribution, triggered by light touch such as eating, talking or a breeze. MRI is arranged to look for a cause.
The attacks are extremely brief, lasting seconds to under two minutes, and extremely severe, described as electric shock, stabbing or lancinating. They occur in the distribution of one or more branches of the trigeminal nerve, most often the cheek and jaw, and are almost always one-sided. Between attacks there is typically no pain at all. Triggering by innocuous stimuli is highly characteristic: light touch, a cold breeze, chewing, brushing teeth, shaving or talking.
In classical trigeminal neuralgia the neurological examination is normal, including facial sensation, which can seem surprising given the severity. Sensory loss, weakness of the chewing muscles, or involvement of both sides suggests a secondary cause and lowers the threshold for further investigation considerably. Dental causes are commonly considered first and many people have unnecessary dental work before the diagnosis is made, which is worth knowing.
MRI is generally arranged, for two reasons. It looks for a vessel compressing the trigeminal nerve where it leaves the brainstem, which is the commonest underlying mechanism and is relevant to treatment. It also excludes secondary causes including multiple sclerosis, which can present this way, and tumours affecting the nerve. Imaging is arranged at an imaging centre since these offices have no imaging suite, and the report is reviewed here. Occipital and other nerve blocks are available within the practice.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: National Institute of Neurological Disorders and Stroke; MedlinePlus: headache; American Academy of Neurology.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.