A patient reports unilateral shooting facial pain in short bursts. Which diagnosis is most likely?

• A. Trigeminal neuralgia
• B. Trigeminal neuritis
• C. Atypical facial pain
• D. Migraine

Answer: (B)

Paroxysmal, electric‑shock–like unilateral facial pain is the classic pattern for trigeminal neuralgia. These attacks are sudden, brief, and intense, lasting only moments, but they can recur in bursts and affect one side of the face along the distribution of the trigeminal nerve. They’re often triggered by light touch, chewing, speaking, or even a breeze, which is a key feature of this condition.

Trigeminal neuritis, by contrast, tends to produce more continuous or longer-lasting facial pain from inflammation of the nerve and may be associated with sensory changes. It does not typically present as the brief, repeated shocks seen in trigeminal neuralgia.

Atypical facial pain usually manifests as a constant, dull ache rather than sharp, episodic bursts and lacks the distinctive trigger-based paroxysms.

Migraine can involve unilateral facial pain, but it is characteristically part of a throbbing headache with other symptoms such as nausea, photophobia, or phonophobia, and it lasts longer than a few seconds to minutes.

Thus, the abrupt, brief, unilateral, shock-like attacks described are most consistent with trigeminal neuralgia.