Painful facial twitching is one of the main symptoms of trigeminal neuralgia, sometimes called “facial pain” and easily confused with toothache. Trigeminal neuralgia is one of the most common diseases in neurosurgery and one of the most difficult diseases in international recognition. Most trigeminal neuralgia starts at the age of 40, mostly occurs in middle-aged and elderly people, especially in women, and its onset is more on the right side than on the left side. The painful facial twitches caused by trigeminal neuralgia are sudden, without any aura, mostly on one side. When the attack occurs, the pain is as intense as a knife cut or electric shock and lasts for several seconds to 1-2 minutes, often accompanied by facial muscle twitching, lacrimation, salivation, facial flushing, conjunctival congestion, etc. As the condition worsens, the interval becomes shorter and the attacks become more frequent. The diagnosis of painful face twitching caused by trigeminal neuralgia is based on: 1. For the differential diagnosis of trigeminal neuralgia, experts say that the duration of the attack of this disease is short, only a few seconds to 1 to 2 min or longer each time, and the disappearance of pain is also very sudden. There can be intermittent or continuous attacks. When the attack is severe, the affected side of the face is red, sweating, pupils dilated, lacrimation, nasal mucosa congestion, runny nose, increased saliva distribution, increased temperature and swelling of the affected side of the skin. If the disease is prolonged and frequent, dystrophic changes may occur, such as local skin roughness, loss of eyebrows, corneal edema and decreased transparency, sometimes producing paralytic keratitis. 2.Finding the trigger point is also one of the methods to identify trigeminal neuralgia. A slight stimulation can cause a painful flare-up, what is the trigger point of trigeminal neuralgia? That is, slight stimulation of the face or a point of the lips, tongue, gums or nose can cause a painful flare-up, and this allergic point that causes severe pain is called the trigger point. The pain starts from the trigger point and radiates along the distribution area of a branch of the trigeminal nerve, not exceeding the midline. Patients often open their mouths, smack their tongues, cover the affected side of the face with their hands, have painful expressions, fidget, and sometimes wake up in pain during sleep. In severe cases, patients do not wash their faces, eat less, suffer from body and even dehydration. 3.Primary trigeminal neuralgia is more common. It refers to trigeminal neuralgia where the exact cause cannot be found. It may be caused by sclerosis of the supplying blood vessels and compression of the nerve, or it may be caused by thickening of the meninges and narrowing of the bone holes through which the nerve passes, resulting in compression and pain. 4.Secondary trigeminal neuralgia refers to trigeminal neuralgia caused by tumor compression, inflammation, or vascular malformation. This type differs from the primary one in that the pain is often persistent and signs of lesions in the adjacent structures of the trigeminal nerve can be detected. What are the typical characteristics of trigeminal neuralgia? Transient episodes of lightning-like, knife-like, burning and tearing pain, often accompanied by twitching of the affected lateral muscles have certain triggers, such as talking, yawning, brushing teeth, rinsing mouth, washing face, shaving, chewing, swallowing and other actions, especially when eating too cold or too hot food can be triggered, and excessive fatigue or mental stress can aggravate the attack. The seizures are more frequent during the day than in the evening. The judgment of these symptoms is also one of the methods to identify trigeminal neuralgia.