Trigeminal Neuralgia

What is trigeminal neuralgia?

Trigeminal neuralgia is a type of nerve pain that affects your face. You may feel a strong burst of pain in part of your face. It is often on one side of the jaw or cheek. The pain may be burning or sharp. It may be so severe that you can’t eat or drink. Trigeminal neuralgia may also be called tic douloureux. The pain comes from the trigeminal nerve, also called cranial nerve 5.

A flare-up may begin with tingling or numbness in the area. Then pain starts to come and go, often in bursts that last anywhere from a few seconds to several minutes. During a flare of the condition, these bursts of pain may occur more often until the pain almost never stops. The pain can be so severe it can make it hard to get through your day. But it’s not life-threatening.

The pain can be set off by pressure on your cheek. This pressure can come from a razor when shaving. Or from your fingers when putting on makeup. Brushing your teeth, standing in the wind, washing your face, eating, drinking, and even talking may also set off attacks of pain.

This chronic pain condition can flare up for a few weeks or months. Then the pain goes away for a while, sometimes years.

What causes trigeminal neuralgia?

This pain condition happens most often in people older than 50. But younger people can also have it. Trigeminal neuralgia is more common in women than men.

Irritation or inflammation of the trigeminal nerve causes trigeminal neuralgia. In many cases, no specific cause may be found. In some cases, a small blood vessel pressing against the trigeminal nerve triggers the pain. Sometimes multiple sclerosis (MS) causes trigeminal neuralgia. In other cases, trauma or a tumor may be the cause. An MRI or other testing should be done to make sure it is not a tumor or MS.

What are the symptoms of trigeminal neuralgia?

People with trigeminal neuralgia may have these symptoms:

• Flashes of severe pain in the cheek or jaw, rarely on both sides

• Absence pain between the flashes of pain

• The pain feels like electric shocks or like a knife

• Pain is often set off by wind or touching, eating, or brushing your teeth

• Anxiety from the thought of the pain returning

How is trigeminal neuralgia diagnosed?

To diagnose trigeminal neuralgia, your healthcare provider will typically take your health history and do a physical exam. Giving your provider details about the pain may help with making a diagnosis. This includes things such as where and when the pain happens. Imaging tests may be used to try to rule out other causes of pain.

How is trigeminal neuralgia treated?

Most common over-the-counter and prescription pain medicines don’t work for people with this condition. Treatment for trigeminal neuralgia may include:

• Anticonvulsant medicine

• Tricyclic antidepressants

• Surgery, if medicine has failed

• Acupuncture

• Biofeedback

• Stereotactic radiosurgery

• Percutaneous balloon rhizotomy and glycerol rhizotomy

• Radiofrequency ablation

What can I do to prevent trigeminal neuralgia?

Experts don’t know how to prevent trigeminal neuralgia. You may learn to stop doing certain activities that seem to set off the pain more than others.

How do I manage trigeminal neuralgia?

This condition is not fatal. But the pain and anticipation of the pain can interfere with your life. Working closely with your healthcare provider will help you find the best pain management methods for you. Alternative therapies have also been shown to help. These include acupuncture and biofeedback. Professional counseling may help you manage the emotional impact of this condition.

When should I call my healthcare provider?

Call your healthcare provider right away if any of the following occur:

• Fever of 100.4°F (38°C) or higher, or as directed by your provider

• Headache with very stiff neck

• Repeated vomiting (You aren't able to keep liquids down.)

• Extreme drowsiness or confusion

• Dizziness or fainting

• A new feeling of weakness or numbness or tingling in your arm, leg, or face

• Trouble speaking or seeing

• Inability to eat or drink

• Feelings of sadness, hopelessness, or anxiety due to ongoing pain and uncertainty

Key points about trigeminal neuralgia

• Trigeminal neuralgia is a type of nerve pain that affects your face. The pain may be so severe you can’t eat or drink.

• Pain is often triggered by wind or touching the cheek, eating, drinking, talking, or brushing your teeth.

• Most common over-the-counter and prescription pain medicines don’t work for people with this condition.

• Treatment may include specialized medicines, surgery, and alternative therapies, such as acupuncture and biofeedback.

• This condition is not fatal. But the pain and anticipation of the pain can interfere with your life.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends.