Severe Facial Pain in Multiple Sclerosis

Trigeminal Neuralgia and MS
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Trigeminal neuralgia is a rare painful condition often experienced by people with multiple sclerosis (MS). In fact, it may be one of the first symptoms of MS.

This disorder entails a type of pain called “neurogenic pain," as it stems directly from the disease process of multiple sclerosis. Demyelination (the loss of the myelin sheath surrounding nerve fibers) is what triggers this disorder in people with MS.


Trigeminal neuralgia is caused by lesions of the trigeminal nerve, which is also called the fifth cranial nerve. The 12 cranial nerves emerge directly from the brain (instead of from the spinal cord), and the trigeminal nerve controls the muscles needed for chewing. The trigeminal nerve is also responsible for most facial sensation.

A person can develop trigeminal neuralgia without having multiple sclerosis. In this instance, one can find changes in the trigeminal nerve root from vascular compression or no abnormalities at all. This type of trigeminal neuralgia is called classical trigeminal neuralgia. When trigeminal neuralgia is caused by MS, it's referred to as secondary trigeminal neuralgia.

Trigeminal neuralgia is fairly rare, with only 4 percent of people with MS experiencing this kind of pain. However, people with MS are 400 times more likely than the general population to have an episode of trigeminal neuralgia.

Signs and Symptoms

Trigeminal neuralgia, sometimes called tic doloureux (French for “painful twitch”), is perhaps the most intensely painful MS-related symptom.

Here are some basic features of this disorder:

  • Occurs almost always on one side of the face, although it may occur bilaterally (both sides) in about 10 percent of people with MS who have the condition.
  • Feel like an electrical jolt and/or sharp, intense, pain
  • Usually, the most intense pain is short-lived (from a few seconds to up to two minutes), but can result in a more constant burning or aching sensation

Interestingly, the pain of trigeminal neuralgia can extend as far as the ear, and sometimes be mistaken for the pain of an ear infection. In addition to being triggered by talking, chewing, drinking, or brushing the teeth, trigeminal neuralgia can be triggered by loud sounds or gusts of cold air.

Given the location and nature of the pain associated with trigeminal neuralgia, it's often mistaken for dental pain. This can lead to unnecessary (and irreversible) procedures like tooth extractions, root canals, and even procedures to reposition the jaw.

This is why it's especially important to see your neurologist if you think you may be experiencing trigeminal neuralgia, especially before undergoing any kind of drastic dental work.

Each episode of trigeminal neuralgia usually lasts a couple of weeks. Episodes tend to recur and can happen as often as every couple of months, although some people will go years between episodes. Unfortunately, as time passes, the time between bouts generally gets shorter.


If you have trigeminal neuralgia, your doctor may prescribe either Tegretol (carbamazepine) or Trileptal (oxcarbazepine) to ease symptoms.

Other medications may include:

  • Baclofen: A muscle relaxant
  • Lamictal (lamotrigine): An anti-seizure medication
  • Botulinum toxin type-A (Botox): An injection into areas of the head and neck called trigger zones

In addition to seeing your neurologist and taking medication (if needed), reaching out to a support group may also be beneficial for the psychological manifestations of trigeminal neuralgia. Finally, some people do require surgery for the condition.

Living With Trigeminal Neuralgia

Trigeminal neuralgia can get so severe and distressing that it may require hospitalization and painkillers given through your vein (intravenous). It can also interfere with a person’s drinking of fluids, so these sometimes have to be given intravenously as well. 

Aside from the physical distress trigeminal neuralgia causes, a person often experiences psychological distress. Many people have anxiety and fear about the possibility of it recurring, which can cause significant suffering and interfere with daily life.

A Word From Verywell

Trigeminal neuralgia is a painful and debilitating condition. As it can be one of the first signs of MS, be sure to see your doctor if you develop any of the symptoms.

In the end, remain resilient as you navigate your treatment options with your doctor.

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