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Trigeminal neuralgia — SCE Neurology MCQ

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HardHeadacheTrigeminal neuralgiaSCE Neurology

A 27-year-old woman presented with brief electric shock facial pain triggered by shaving and talking. On examination, neurological examination was normal and there was no sensory loss. Initial investigations showed: MRI excluded secondary trigeminal compression. What is the most likely diagnosis?

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Correct answer: E — Trigeminal neuralgia

Trigeminal neuralgia is the best answer because the vignette describes Trigeminal neuralgia: paroxysmal triggerable facial pain is trigeminal neuralgia. Idiopathic intracranial hypertension is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Subarachnoid haemorrhage headache and Cervicogenic headache are less appropriate because they would require different localisation, timing or test findings; Medication-overuse headache would fit a different syndrome. Clinical pearl: cluster headache lasts longer and has autonomic eye signs.

Reference: NICE CG150; BASH headache guidance; BNF