Do I have a toothache or trigeminal neuralgia? Many people have had a toothache. Toothache, is a persistent pain, with obvious onset at night, aggravated by hot and cold stimulation, with deep, non-dischargeable pain at the site. Dental diseases such as dental caries, residual roots, and residual crowns can be detected through oral examination. In contrast, trigeminal neuralgia is mainly intermittent pain, usually not more than a few minutes each time. How exactly are the symptoms of trigeminal neuralgia different from toothache? Trigeminal neuralgia is a common disease in people’s lives, especially in middle-aged and elderly patients. Many elderly patients with trigeminal neuralgia, who will have symptoms of toothache, will often mistake it for toothache. Because they do not know how to make early diagnosis of trigeminal neuralgia and toothache, they are often treated in dentistry for a long time, and even finally tooth extraction cannot stop the pain, and delay the treatment of trigeminal neuralgia. Yuan Sutao, Department of Neurosurgery, Fujian Provincial Hospital Patients with trigeminal neuralgia often have “trigger points” on the face, that is, certain parts of the face are particularly sensitive and easily trigger pain. While general painkillers work when toothache is present, painkillers for trigeminal neuralgia are often ineffective. The pain of trigeminal neuralgia in the elderly is cyclical, and when it is not painful, everything is normal, but when it is painful, it seriously affects eating and resting, and even “painful”. Trigeminal neuralgia seriously affects people’s daily life, therefore, patients with trigeminal neuralgia, especially the elderly, should not only receive treatment as early as possible, but also choose a suitable treatment method in order to treat trigeminal neuralgia well. The treatment of trigeminal neuralgia is divided into conservative treatment and surgical treatment, the former includes oral medication and drug injection nerve block treatment. Carbamazepine is a commonly used pain medication, but dizziness, drowsiness, unstable walking as well as skin rash, liver damage and bone marrow suppression can occur when taken for a long time or in too large a dose. The main problems of this treatment are high recurrence rate of pain (23%-54%) and facial numbness, corneal ulceration and chewing difficulty caused by nerve damage. At present, surgical treatment mainly adopts microvascular decompression surgery, which is performed under the operating microscope to push away the blood vessels located at the root of the trigeminal nerve that are abnormal and cause pressure on the trigeminal nerve, and fix them so that they do not touch the trigeminal nerve, thus relieving the pressure of the blood vessels on the root of the trigeminal nerve, restoring the normal function of the trigeminal nerve, and relieving the pain symptoms. With the improvement of this surgical technique, especially its characteristics of minimally invasive, high safety, remarkable effect and low recurrence rate and complications, especially the ability to completely preserve the function of blood vessels and nerves, it has become the most effective treatment method for trigeminal neuralgia. In addition, microvascular decompression has been successfully used to treat facial muscle spasm, glossopharyngeal neuralgia, as well as intractable vertigo, tinnitus, neurogenic hypertension, and spastic diagonal neck. The procedure is performed under general anesthesia and is painless for the patient. The surgical incision is made in the hairline behind the affected ear, about 125px long, and a small hole of 2-75px in diameter is drilled in the skull. Many elderly patients are worried about the risk of receiving surgical treatment at an older age, but in fact, trigeminal nerve microvascular decompression surgery is a very safe and minimally invasive procedure. The time is short, the trauma is small, and there is no difference in the postoperative complication and cure rate between elderly and young and middle-aged patients according to statistics, as long as they are evaluated by formal examination before surgery.