Differentiation between “neuralgic” versus “neuropathic” pain always has been a challenging subject. In the trigeminal nerve both “neuralgic” and “neuropathic” involvement preset with “facial pain” which despite being two different pathologies, clinical presentation can be similar. This differentiation even becomes a controversial matter, depends on which specialist evaluate the patient. The diagnostic criteria for facial pains can be found both in the International Association for the Study of Pain (IASP) classification and in the International Headache Classification (ICHD-3); there are some variations between the two classifications. In practice this differentiation is critical matter since treatment of “neuralgic” pain of trigeminal nerve (also calls as trigeminal neuralgia) could totally be different than treatment of “neuropathic” pain. Particularly since invasive surgical option (microvascular decompression) is one the best treatment for trigeminal neuralgia, it is extremely important to differentiate between two conditions to avoid unnecessary surgery which most of the time will make the neuropathic pain even worse. We will discuss key features in this subject using case presentation and clinical scenario with some points in role of imaging modality and laboratory findings to help this differentiation.

Hossein Ansari, MD, FAAN, FAHS is a board-certified neurologist and certified headache specialist.
Dr. Ansari finished medical school in Iran and after working as Emergency room physician for 5 years; he moved to United States and started his residency at Neurology in University of West Virginia which he also served as Chief resident. After completing his neurology residency, he completed a fellowship on headache and facial pain at the Mayo Clinic in Rochester, Minnesota.
After obtaining his certification in both neurology and headache medicine, Dr. Ansari moved to Ohio where he established a multidisciplinary headache center at Neuroscience Center at
“Neurology & Neuroscience Associates Inc.” in Akron, Ohio, and served as the headache center’s director. He was also an assistant professor at Northeast Ohio Medical University and an attending neurologist at Summa Health System.
In 2015 moved to San Diego to establish headache and facial pain clinic for the University of California, San Diego (UCSD) . He is currently associate professor at the neuroscience department and director of Headache and Facial pain clinic where takes care of thousands of patients with headache/face pain every year .
Dr. Ansari is actively involved in multiple domestic and international professional societies and serves as an advisory council member for the International Headache Society. He has also fellow of both American academy of Neurology (AAN) and American headache society (FAHS). He had multiple presentations at annual national and international conferences as keynote speaker.