Facial Pain Mimicking Trigeminal Neuralgia Secondary to Low-Cervical Spondylosis: A Case Report and Comprehensive Literature Review

Trigeminal neuralgia (TN) is usually associated with neurovascular compression at the root entry zone. However, atypical presentations may result from secondary underlying pathologies. Cervical spondylosis (CS) is a rare cause, and its pathophysiologic mechanism leading to facial pain remains poorly understood. Here, we present a case of a 53-year-old woman with a one-year history of migraine episodes refractory to multiple medications. She subsequently developed sudden, severe left-sided trigeminal-like facial pain. Brain magnetic resonance imaging (MRI) excluded vascular compression or intracranial pathology, while cervical spine MRI revealed disc bulging at lower cervical levels. The patient underwent anterior cervical discectomy and fusion (ACDF) at C5-C6, achieving immediate and sustained resolution of facial pain and migraines. This case highlights the importance of evaluating the entire trigeminal pathway, including the cervical spine, when assessing patients with atypical or refractory TN, as an appropriate diagnostic approach and surgical management can lead to definitive symptom relief.