Zakrzewska and Linskey listed a number of red flags that may identify a patient with apparent trigeminal neuralgia who may have a more serious underlying disorder. The authors are from Eastman Dental Hospital in London and the University of California in Irvine.
Red flags:
(1) sensory changes accompanying the pain
(2) ear problems (deafness, other)
(3) history of cancer (see previous section)
(4) history of skin or oral lesion associated with perineural spread
(5) ophthalmic division only
(6) bilateral pain (can occur with trigeminal neuralgia but rare)
(7) findings associated with multiple sclerosis (family history, optic neuritis)
(8) age of onset less than 40 years of age
(9) difficulty with pain control
(10) poor response to carbamazepine or other antiepileptic drug
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