Diagnostic Questions for Trigeminal Neuralgia
A helpful questionnaire for the diagnosis and treatment of patients suffering from varies types of trigeminal neuralgia.
1.
When you have pain, is it predominantly in your face (i.e., forehead, eye, cheek, nose, upper/lower jaw, teeth, lips, etc)?
yes no
2.
Do you have pain just on one side of your face?
yes no
3.
Is your pain either entirely or mostly brief (seconds to minutes) and unpredictable sensations (electrical, shocking, stabbing, shooting)?
yes no
4.
Do you have any constant background facial pain (e.g., aching, burning, throbbing, stinging)?
yes no
5.
Do you have constant background facial pain (aching, burning, throbbing, stinging) for more than half of your waking hours?
yes no
6.
Do you have any constant facial numbness?
yes no
7.
Can your pain start by something touching your face (for example, by eating, washing your face, shaving, brushing teeth, wind)?
yes no
8.
Since your pain began have you ever experienced periods of weeks, months, or years, when you were pain-free? (This would not include periods after any pain-relieving surgery or while you were on medications for your pain.)
yes no
9.
Have you ever taken Tegretol® (carbamazepine), Neurontin® (gabapentin), Lioresal® (baclofen), Treleptal® (oxcarbazepine), Topamax® (topiramate), Zonegran® (zonisamide), or any other anticonvulsant medication for your pain?
yes no
10.
Did you ever experience any major reduction in facial pain (partial or complete) from taking any of the medications listed in Question 9, or any anticonvulsant medication?
yes no
11.
Have you ever had trigeminal nerve surgery for your pain? (e.g., neurectomy, RF rhizotomy/gangliolysis, glycerol injection, balloon compression, rhizotomy, MVD, gamma knife)
yes no
12.
Have you ever experienced any major reduction in facial pain (partial or complete) from trigeminal nerve surgery for your pain? (e.g., neurectomy, RF rhizotomy/gangliolysis, glycerol injection, balloon compression, rhizotomy, MVD, gamma knife)
yes no
13.
Did your current pain start only after trigeminal nerve surgery (neurectomy, RF rhizotomy/gangliolysis, glycerol injection, balloon compression, rhizotomy, MVD, gamma knife)? (If this is a recurrence of your original pain after a successful trigeminal nerve surgery, answer "no")
yes no
14.
Did your pain start after facial zoster or"shingles" rash (Herpes zoster - not to be confused with "fever blisters" around the mouth)?
yes no
15.
Do you have multiple sclerosis?
yes no
16.
Did your pain start after a facial injury?
yes no
17.
Did your pain start only after facial surgery (oral surgery, ENT surgery, plastic surgery)?
yes no
18.
When you place your index finger right in front of your ears on both sides at once and feel your jaw open and close does the area under your fingers on either side hurt?
yes no
19.
Do you have facial pain?
yes no
20.
Do you remember exactly where you were the moment your facial pain started?
yes no