Trigeminal Neuralgia — ORE Part 1 MCQ

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ModerateOral MedicineTrigeminal NeuralgiaORE Part 1

A 40-year-old man presents complaining of episodes of severe, lancinating, electric shock-like pain in the right side of his face, triggered by light touch on the right cheek. The pain lasts seconds and occurs in clusters. Between episodes, there is no pain. What is the most likely diagnosis?

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Correct answer: A — Trigeminal neuralgia

Explanation lettering: D = shown as B · E = shown as C · C = shown as D · B = shown as E

The answer is A (Trigeminal neuralgia). Classical trigeminal neuralgia type 1 is characterised by sudden-onset, severe, lancinating pain in the trigeminal distribution, triggered by light touch or other innocuous stimuli, lasting seconds, with pain-free intervals. This patient's presentation—unilateral shock-like pain on the cheek triggered by light touch, lasting seconds—exactly matches NICE and international ICHD-3 criteria. Atypical facial pain (B) presents as constant, lower-intensity aching, not paroxysmal attacks. Cluster headache (C) is a primary headache disorder affecting the orbit/supraorbital region. Glossopharyngeal neuralgia (D), though similar to trigeminal neuralgia, affects the glossopharyngeal nerve distribution (tongue, pharynx, ear). Temporomandibular disorder (E) involves jaw dysfunction, tenderness, and joint sounds, not characteristic neuralgia. The discriminating feature is the paroxysmal nature, shock-like quality, and trigger by light touch.

Reference: NICE Interventional Procedure Guidance 715 (2004, updated). Stereotactic radiosurgery for trigeminal neuralgia. Section 2: The condition, current treatments and procedure. https://www.nice.org.uk/guidance/ipg715/chapter/2-The-condition-current-treatments-and-procedure