Trigeminal neuralgia vs Cluster headache and temporal arteritis
How to tell Trigeminal neuralgia and Cluster headache and temporal arteritis apart when a board question makes them look alike.
Trigeminal neuralgia is triggerable electric facial pain; cluster is orbital autonomic headache; temporal arteritis is older patient with jaw/scalp/vision inflammatory clues.
Side by side
Brief electric shock-like unilateral facial pain in trigeminal nerve distribution triggered by touch, chewing, talking, or brushing teeth, with normal exam between attacks.
Cluster headache causes severe unilateral orbital pain with ipsilateral autonomic signs; temporal arteritis causes older-age headache with scalp tenderness, jaw claudication, vision risk, and elevated ESR/CRP.
Often from trigeminal nerve root irritation or vascular compression causing paroxysmal neuropathic pain.
Cluster headache is trigeminal autonomic cephalalgia; temporal arteritis is granulomatous large-vessel vasculitis involving branches of the carotid artery.
Clinical triggerable brief facial pain supports trigeminal neuralgia; imaging is used when secondary causes are suspected.
Ipsilateral tearing/rhinorrhea/ptosis supports cluster; elevated ESR/CRP and temporal artery biopsy support temporal arteritis.
The trap
Unilateral head or face pain overlaps, so duration, triggers, autonomic signs, and age/inflammatory markers decide.
The repair move
For unilateral face/head pain, ask whether it is electric and triggerable, autonomic and orbital, or inflammatory with vision risk.
Try a free question
CoreA patient has seconds-long electric shock-like pain over the right cheek triggered by brushing teeth or chewing. Neurologic exam is normal between attacks. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Trigeminal neuralgia. Brief triggerable electric facial pain in a trigeminal distribution supports trigeminal neuralgia.
Why the other choices are tempting
- B. Cluster headache causes longer orbital attacks with autonomic signs.
- C. Temporal arteritis occurs in older adults with inflammatory scalp, jaw, or vision clues.
- D. Migraine lasts hours and has nausea or sensory sensitivity.
- E. Bell palsy causes facial weakness, not electric pain.
Flashcards
Tap a card to flip it.
What pain quality points to trigeminal neuralgia?
Brief electric shock-like facial pain points to trigeminal neuralgia.
What triggers point to trigeminal neuralgia?
Touch, chewing, talking, or brushing teeth can trigger trigeminal neuralgia.
Quick answers
What is the fastest way to tell Trigeminal neuralgia from Cluster headache and temporal arteritis?
Trigeminal neuralgia is triggerable electric facial pain; cluster is orbital autonomic headache; temporal arteritis is older patient with jaw/scalp/vision inflammatory clues.
What is the key clue for Trigeminal neuralgia?
Brief electric shock-like unilateral facial pain in trigeminal nerve distribution triggered by touch, chewing, talking, or brushing teeth, with normal exam between attacks.
What is the key clue for Cluster headache and temporal arteritis?
Cluster headache causes severe unilateral orbital pain with ipsilateral autonomic signs; temporal arteritis causes older-age headache with scalp tenderness, jaw claudication, vision risk, and elevated ESR/CRP.
What is the common trap with Trigeminal neuralgia vs Cluster headache and temporal arteritis?
Unilateral head or face pain overlaps, so duration, triggers, autonomic signs, and age/inflammatory markers decide.