Trigeminal neuralgia is a condition characterized by intermittent pain, usually on one side of the face, somewhere along the distribution of the trigeminal nerve (ear to eye, nose and jaw). Sometimes there's a headache with it (same side), sometimes not.

If there are no other symptoms and it goes away for months at a time, and the pain can be largely controlled by avoiding triggers and taking ibuprophen, is it really necessary to have imaging studies done to rule out compression of the nerve or the small chance that it's the first sign of MS?

If such a condition has been occurring intermittently for years, if it was caused by a compression of the nerve, wouldn't there be definitive symptoms after such a period of time? If it were MS, would other signs have manifested themselves during a period of years?

  • I want to say no, additional symptoms should have arisen in the time frame, but I'm struggling to think of what the source would be to back that up. I'm leafing through old textbooks at the moment.
    – Atl LED
    Jan 30 '16 at 2:34

Formal Guideline

Please see the guideline. The answer to your question relies on the mix of guidelines as well as your specific situation. I can only give you information in general (See above) but should not and cannot accurately say anything about you personally, obviously.

In general, if your pain is well controlled, then it seems like surgery would not really be something you want (there are obvious risks of head surgery). So the question is what else would the MRI reveal that would change the course of your illness. If for pain you would not need it, then what else? Multiple sclerosis (MS) is certainly on the differential for many many symptoms, but if you and your doctor think it is highly highly unlikely based on your history, then it might not be something you want to formally rule out with an MRI.

If the concern is for a growing mass (such as cancer), the MRI can certainly be helpful.

There is no great evidence for a person in your situation. It will have to be a decision that you and your provider make after considering the risks and benefits.

To answer your secondary questions, your presentation is not consistent with MS diagnostically, as the McDonald criteria requires a person who has had more than 1 attack in just 1 clinically suggestive location, to have some kind of dissemination in SPACE. You have only one location thus far. Regardless, progression of MS can take years to decades. Without further information, it would be hard to say in your case how unlikely it is that you have something that will progress to MS. You can talk to your provider.

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