Burchiel AuditFacial Pain Selection MatrixPatient Education GuideDiagnostic ManifestTN1TN Type 1 (Classic)Episodic, sharp, shooting, electric-like pain. Intermittent pain-free intervals.TN2TN Type 2 (Atypical)Constant aching, throbbing, or burning. Presents >50% of the symptomatic time.NPNeuropathic PainResulting from unintentional injury (e.g., facial trauma or dental procedures).DPDeafferentation PainResulting from intentional nerve injury (e.g., previous neurectomy or rhizotomy).STNSymptomatic TNTrigeminal neuralgia secondary to an underlying disease (e.g., Multiple Sclerosis).AFPAtypical Facial PainPain predominantly persistent and does not fit strict clinical criteria.Standardized TriageThe Burchiel classification is the clinical benchmark for determining surgical candidate eligibility for Microvascular Decompression (MVD).Surgical Selection ProbeSelect the clinical pain pattern to establish the Burchiel class and identify the evidence-weighted prognosis for surgical intervention. Guidelines & EvidenceClinical DetailsSection 1When to UseWhen to UseClassifying phenotypes of trigeminal neuralgia (TN) based on pain characteristics.Distinguishing classical TN from secondary TN (symptomatic of MS, tumor, etc.).Guiding medical vs. surgical management.Predicting response to medical therapy or need for surgical intervention.Patient PopulationApplicable to all patients with suspected trigeminal neuralgia. Critical to identify secondary causes before pursuing ablative procedures.Section 2Formula & LogicBurchiel Classification SystemType 1 (Classical)Purely paroxysmal; electric shock pain, trigger zones presentType 2 (Intermediate)Paroxysmal pain plus continuous background burning/achingType 3 (Atypical)Purely continuous pain without paroxysmal components; rare diagnosisSection 3Pearls/PitfallsSecondary TN Red FlagsAge < 40 at symptom onset (consider MS, tumor).Bilateral TN presentation (highly suspicious for MS).Atypical pain quality or distribution.Progressive neurological deficits beyond TN.Absence of trigger zones or distinctive shock-like character.Section 4LiteratureYale NeurosurgeryDeveloped by Kenneth Burchiel, MD at Yale University in 2003 to more precisely phenotype trigeminal neuralgia and improve clinical decision-making.Section 5Evidence AppraisalOriginal ClassificationA new classification for facial painBurchiel KJ. • Neurosurgery. 2003;53(5):1164-1166View Source Section 6Next StepsRelated Tools BNI Pain Intensity Score Trigeminal Neuralgia Decision Tree Gamma Knife Selection Microvascular DecompressionLast Comprehensive Review: 2026
