Trigeminal neuralgia most commonly begins after the age of 50 and is more common in women.
Causes
The most common cause is pressure on the trigeminal nerve near the brainstem.
Blood Vessel Compression
An artery or vein may press against the trigeminal nerve and damage its protective myelin coating. This can cause the nerve to send abnormal pain signals.
Multiple Sclerosis
Multiple sclerosis can damage myelin around the trigeminal nerve and may be a likely cause when trigeminal neuralgia develops in a younger person.
Tumour or Cyst
Rarely, a growth may press on the trigeminal nerve.
Nerve Injury
Damage following facial trauma, dental procedures or sinus surgery may occasionally contribute.
In some people, no clear cause is identified.
Symptoms
The main symptom is sudden facial pain that may feel:
Electric shock-like
Shooting
Stabbing
Extremely sharp
Each attack may last from a fraction of a second to about two minutes.
Pain may affect the:
Cheek
Jaw
Teeth
Gums
Lips
Eye or forehead less commonly
The pain is almost always limited to one side of the face.
Attacks may occur many times in a single day and can come in clusters, followed by pain-free periods lasting weeks or months.
Some people also develop a constant dull or aching pain between attacks.
Common Triggers
Even very light touch or normal everyday activities can trigger an attack.
Common triggers include:
Chewing
Talking
Smiling
Brushing the teeth
Washing the face
Shaving
Applying make-up
A light breeze touching the face
Because the pain is often felt in the teeth or jaw, some people first visit a dentist and may undergo unnecessary dental treatment before trigeminal neuralgia is recognised.
Diagnosis
Diagnosis is based mainly on the characteristic pattern of pain.
A doctor or neurologist will consider:
Where the pain occurs
Its electric shock-like quality
How long each attack lasts
What triggers the pain
A neurological examination may also be performed.
MRI Scan
An MRI of the brain is usually advised to look for possible causes such as:
Blood vessel compression
Multiple sclerosis
Tumour or cyst
Dental causes of facial or jaw pain should also be excluded.
Treatment
Treatment usually begins with medicines.
Ordinary painkillers such as paracetamol and ibuprofen generally do not relieve trigeminal neuralgia pain.
Carbamazepine
Carbamazepine is commonly the first-choice medicine and can be highly effective.
A strong response may also support the diagnosis.
Regular blood tests may be required during treatment.
Possible side effects include:
Drowsiness
Dizziness
Low sodium levels
People of Han Chinese, Thai and some other Asian ancestry may need testing for the HLA-B*1502 gene before starting carbamazepine because of the risk of a serious skin reaction.
Oxcarbazepine
Oxcarbazepine works in a similar way to carbamazepine and may be better tolerated in some people.
Other Medicines
Other options may include:
Baclofen
Lamotrigine
Gabapentin
Pregabalin
These may be used alone or in combination.
Doses are usually started low and increased gradually. Medicines should not be stopped suddenly without medical advice.
Surgery and Procedures
Surgery or other procedures may be considered when medicines no longer control the pain or cause unacceptable side effects.
Microvascular Decompression
Microvascular decompression, or MVD, involves moving the blood vessel away from the trigeminal nerve and placing a small cushion between them.
It can provide long-lasting pain relief while preserving facial sensation, but it is a major operation performed under general anaesthesia.
Gamma Knife Radiosurgery
Gamma Knife radiosurgery uses focused radiation to target the trigeminal nerve root without an incision.
Pain relief may take weeks or months to develop.
Percutaneous Procedures
These treatments intentionally damage part of the nerve to reduce pain signals.
Options include:
Radiofrequency rhizotomy
Glycerol injection
Balloon compression
These procedures can provide rapid pain relief and may be suitable for older people or those unable to undergo major surgery.
However, facial numbness is common and the pain may return over time.
The choice of treatment depends on:
Age
General health
MRI findings
Response to medication
Personal preferences
Living With Trigeminal Neuralgia
The fear of another pain attack can interfere with eating, talking, sleeping and everyday activities.
It may also contribute to:
Weight loss
Anxiety
Depression
Social withdrawal
Helpful strategies include:
Keeping a diary of attacks and triggers
Eating softer foods if chewing triggers pain
Using a straw when appropriate
Washing the face with lukewarm water
Using a soft toothbrush
Maintaining good dental hygiene
Protecting the face from cold wind with a scarf
Taking medicines regularly rather than only during attacks
Seeking counselling or support when needed
When to See a Doctor
See a doctor if you develop:
Brief but severe electric shock-like facial pain
Pain triggered by touching the face
Pain triggered by eating, talking or brushing the teeth
Recurrent unexplained jaw or tooth pain
Before undergoing a tooth extraction for unexplained facial or dental pain, it is reasonable to ask whether trigeminal neuralgia has been considered.
Seek urgent medical attention if facial pain occurs together with:
Numbness
Weakness
Vision changes
Difficulty speaking
The Bottom Line
Trigeminal neuralgia is a chronic nerve pain condition that causes sudden, intense facial pain, often triggered by everyday actions such as eating, talking or touching the face.
Although the pain can be severe, medicines and surgical procedures can provide effective relief for many people. Early diagnosis is especially important because the condition can sometimes be mistaken for dental pain.
