Trigeminal Neuralgia

What Is Trigeminal Neuralgia?

Trigeminal neuralgia is an ongoing pain condition that affects certain nerves in your face. You might also hear it called “tic douloureux.”

People who have this condition say the pain might feel like an electric shock, and it can sometimes be intense.

Doctors have treatments that can help, including medicine and surgery.

Mapping the Nerves in Your Face

To learn about trigeminal neuralgia, it helps to know a little about how the affected nerves are laid out.

In your head, you have 12 pairs of what are called cranial nerves. The trigeminal nerves are among these pairs, and they let you feel sensations in your face. One nerve runs down each side of your head.

Each trigeminal nerve splits into three branches, controlling the feeling for different parts of your face. They are:

  • The ophthalmic branch. It controls your eye, upper eyelid, and forehead.
  • The maxillary branch. This affects your lower eyelid, cheek, nostril, upper lip, and upper gum.
  • The mandibular branch. It runs your jaw, lower lip, lower gum, and some muscles you use for chewing.

The disorder can affect any of the three nerve branches, meaning you could feel pain from your forehead to your jaw. Usually, you’ll feel pain on only one side of your face. Some people feel it on both sides. When that happens, it’s called bilateral trigeminal neuralgia.

Trigeminal Neuralgia Symptoms

You may feel as though your pain came out of nowhere. Some people with this condition start out thinking they have an abscessed tooth and go to a dentist.

For people who have what’s called “atypical” trigeminal neuralgia, known as type 2, the pain is usually less intense, but constant.

Doctors consider sudden and intense bouts of pain to be signs of “classic” trigeminal neuralgia. If your pain is more of an aching, burning sensation, you might have the atypical form.

Common symptoms of trigeminal neuralgia may include:

  • Brief periods of stabbing or shooting pain.
  • Pain triggered by things such as brushing your teeth, washing your face, shaving, or putting on makeup. Even a light breeze against your face might set off your pain.
  • You may feel it coming on, as burning or achiness, before it becomes very painful.
  • Episodes last a few seconds to several minutes.
  • The attacks happen several times a day or a week, followed by periods during which you have none at all. These pain-free periods are known as remission.
  • Pain usually affects only one side of the face.
  • Pain may affect just one part of your face or spread to a wider area.
  • Episodes happen more often over time, and the pain can worsen.
  • You feel the pain mostly in your cheek, jaw, teeth, gums, and lips. The eyes and forehead are affected less often.
  • After an attack, your face may twitch uncontrollably.

Some people with this condition also have anxiety because they are uncertain when the pain will return.

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Trigeminal Neuralgia Triggers

Any number of things may cause trigeminal neuralgia pain, such as:

  • Gently touching your face
  • Shaving
  • Washing your face
  • Brushing your teeth
  • Applying makeup
  • Blowing your nose
  • Eating or drinking, especially hot or cold foods or drinks
  • Talking
  • Smiling
  • Having wind or a breeze blow at you

Trigeminal Neuralgia Causes and Risk Factors

This starts with irritation of the trigeminal nerve. You might have a blood vessel pressing on the nerve, damaging the protective coating around it, which is called the myelin sheath.

Certain diseases, such as multiple sclerosis, also can injure the myelin sheath. Sometimes a tumor or a tangle of arteries presses on the nerve.

Your trigeminal nerve can also be injured -- perhaps by surgery, an accident, or a stroke.

  • Some people are more likely to get trigeminal neuralgia than others:
  • Women are more likely than men to get trigeminal neuralgia.
  • The disease is more common in people older than 50.
  • The disorder may run in families, perhaps because of how blood vessels are formed in the brain.
  • It may also be linked to high blood pressure.

Although the pain can be intense, the condition is not life-threatening. It can be a progressive disease, though, meaning that it gets worse over time.

Trigeminal Neuralgia Diagnosis

If you have facial pain -- especially sensations that keep coming back or don’t respond to over-the-counter pain relievers -- make an appointment with your doctor.

Be ready to tell your doctor about how your pain first appeared, how often you feel it, and what seems to trigger it.

Expect your doctor to ask lots of questions about your condition. You may also have a neurological exam, in which your doctor touches various parts of your face. He can test your reflexes to figure out whether a nerve is compressed.

An imaging test such as an MRI can show if a tumor or multiple sclerosis is an underlying cause of your problem.

Trigeminal Neuralgia Treatments

Treatment for this condition may include medication and surgery.

Medication: Typical pain medications don’t work well for people with trigeminal neuralgia, but your doctor may prescribe different types of drugs:

  • To keep the nerves from reacting to irritation, you may take anticonvulsant medications.
  • You also may take muscle relaxants -- alone or along with anticonvulsants.
  • Your doctor may suggest a tricyclic antidepressant to manage your symptoms.
  • Some research suggests that Botox shots may be helpful when other medication doesn’t relieve trigeminal neuralgia pain. More research is needed before doctors can prescribe this widely.

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Surgery: Over time, your medication may help you less and less. If that happens, you have several surgical options.

Some of these procedures are outpatient, meaning you don’t have to be admitted to a hospital. For some, you’ll need general anesthesia, which means you won’t be awake during the surgery.

Your doctor can help you decide which surgery is right for you, based on your overall health, which nerves are involved, and your preferences.

Procedures to treat trigeminal neuralgia include:

  • Gamma knife radiosurgery, which uses radiation focused on your trigeminal nerve.
  • Balloon compression, in which doctors thread an empty balloon into a space between the trigeminal nerve and the base of the skull. When the balloon is inflated, the nerve is pressed against hard bone, damaging the insulation to the nerve, so that you don’t perceive pain from light touches.
  • Glycerol shot, which is injected into the spinal fluid surrounding the trigeminal nerve at the base of the skull. This injures the insulation around the nerve, which relieves pain.
  • Radiofrequency ablation, in which doctors and patients pinpoint the exact area within the trigeminal nerve causing excessive pain. Then the doctor can send electrical current to the spot to dull the sensation.
  • Microvascular decompression, which moves or takes out blood vessels that are affecting the nerve.
  • Neurectomy, in which the trigeminal nerve is partly cut to relieve pain.

Natural Treatment for Trigeminal Neuralgia

You can explore alternative ways to help manage the symptoms of trigeminal neuralgia. These are some you may want to ask your doctor about:

  • Acupuncture (a Chinese tradition that uses very thin needles to balance the flow of energy in your body)
  • Aromatherapy (the use of plant oils such as peppermint, lavender, etc., to help healing)
  • Meditation
  • Yoga
  • Biofeedback (learning how to control your body to reduce pain)
  • Chiropractic care

WebMD Medical Reference Reviewed by Michael W. Smith, MD on June 24, 2020

Sources

SOURCES:

Mayo Clinic: “Diseases and Conditions -- Trigeminal Neuralgia,” “Biofeedback.”

American Association of Neurological Surgeons: “Conditions and Treatments -- Trigeminal Neuralgia.”

TNA Facial Pain Association: “What Is Trigeminal Neuralgia?”

New York Presbyterian Hospital: “Health Library -- Trigeminal Neuralgia.”

National Institute of Neurological Disorders and Stroke: “Trigeminal Neuralgia Fact Sheet.”

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