The diagnosis of the disease is based on the characteristics of pain attacks, the absence of significant pain in the intervals between paroxysms, the presence of trigger zones on the skin of the face in the oral cavity, provocation of attacks by eating, washing, shaving, etc. In some cases, a false impression can be created about the duration of pain attacks in for several hours, namely: with status neuralgicus – a state of continuously following one after another pain attacks. However, in this situation, a thorough survey allows us to establish the true nature of the attacks. Almost most often it is necessary to differentiate trigeminal neuralgia from Slader syndrome and the so-called migraine neuralgia.
Neuralgia of the terminal branches of the trigeminal nerve
In rare cases, there are neuralgia of individual terminal branches of the trigeminal nerve – the lingual nerve, the superior typhoid nerves, the lower tubular nerve, and the nasociliary nerve. All of them are partial forms of trigeminal neuralgia, are manifested by characteristic pain attacks and trigger zones with limited localization. So, with neuralgia of the lingual nerve, attacks of pain occur in the front 2/3 of the tongue (the corresponding half) and trigger zones are located here. With neuralgia of the superior typhoid nerves, bouts of pain are localized in the region of the teeth and part of the upper jaw, and with neuralgia of the lower tubular nerve in the region of the teeth of the lower jaw, trigger zones are usually found in the area of the corresponding gum or tooth.
Neuralgia of the nasociliary nerve is characterized by bouts of pain in the area of the wing of the nose, eyeball, medial zone of the orbit and frontal region. With this form of partial trigeminal neuralgia , trophic disorders most often develop, namely: dystrophic changes in the cornea and vitreous body, which are detected when the eye is examined with a slit lamp. As a diagnostic test for nasal neuralgia, lubrication with novocaine is used to lubricate the nerve exit site above the superior nasal concha, which relieves a pain attack. Lingual nerve neuralgia should be distinguished from glossopharyngeal nerve neuralgia, in which pain and trigger zones are localized mainly in the area of the tongue root, tonsil, palatine arch, and glossalgia . In the latter case, patients complain of pain, burning sensation, sensation of hair on the tongue, dry mouth. There are no pain attacks and trigger zones. All sensations pass with food. The disease is often a peculiar form of neurosis, however, some patients find changes in the gastrointestinal tract, irritation of the tongue with the edges of the teeth or dentures.