Trigeminal Neuropathy and Trigeminal Neuralgia F003

Current RMA Instruments:

Changes from Previous Instruments:

ICD Coding

• ICD-10-AM Codes: G50.0, G50.8

Brief description:

These SoPs relate to the trigeminal (5^th cranial) nerve, which provides sensation to the face, the top of the head, gums and anterior tongue, and motor function to the muscles of mastication (chewing).

Trigeminal neuropathy is a disease or injury of the trigeminal nerve or ganglion which involves loss of function of the trigeminal nerve, with objective signs as well as symptoms.

Trigeminal neuralgia is a condition resulting in regular episodes of sharp, intense facial pain along the distribution of the trigeminal nerve. Pain can be triggered by routine activities (e.g. talking, brushing teeth, cold air on the face etc.) and an individual's quality of life can be greatly affected by trigeminal neuralgia. 

Confirming the diagnosis:

To confirm the diagnosis, a report from a specialist neurologist is required.

Additional diagnoses covered by these SOPs

• Classical trigeminal neuralgia 
• Secondary trigeminal neuralgia 
• Peripheral painful post-traumatic trigeminal neuropathy
• Postherpetic neuralgia – if in the trigeminal nerve distribution and there are sensory or motor signs
• Tic douloureux (trigeminal neuralgia) 

Conditions not covered by these SOPs   

• Cluster headache with associated facial pain*
• Dental or periodontal pain of local origin #
• Glossopharyngeal neuralgia #
• Postherpetic neuralgia # 
• Migraine with associated facial pain *  
• Neuropathy in other cranial nerves not being in the trigeminal nerve distribution #
• Peripheral neuropathy *
• Persistent idiopathic facial pain – if not in the trigeminal nerve distribution
• Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) #
• Tic Douloureux*    (trigeminal neuralgia)

* another SOP applies  - the SOP has the same name unless otherwise specified

Clinical onset

The clinical onset is the earliest time, prior to the confirmation of the disease, that the pathognomonic symptoms and signs were documented by a doctor. 

Clinical worsening of trigeminal neuropathy

The natural history of trigeminal neuropathy depends on the cause of the pathology. If the cause is an injury, and the injury agent has ceased, the trigeminal neuropathy should not worsen over time but be fixed. If the neuropathy is part of a progressive neurological disease (malignancy, diabetes mellitus, multiple sclerosis), the natural history of the neuropathy will generally track that of the underlying disease.

If it is thought that there is a clinical worsening, it is recommended that an expert opinion be sought from a neurologist to evaluate whether the clinical worsening was out of keeping with the natural history of the underlying pathology.

Clinical worsening of trigeminal neuropathy

A clinical worsening in an episodic disorder such as trigeminal neuralgia is not simply triggering an episode of pain, but would require that the whole episodic pain pattern is worse in intensity, and or increased in frequency and for aggravation (as opposed to aggravation of signs and symptoms) that this clinical worsening is permanent.

If it is thought that there is a clinical worsening, it is recommended that an expert opinion be sought from a neurologist to evaluate whether the clinical worsening was out of keeping with the natural history of the underlying pathology.