Overview of Trigeminal Neuralgia

Understanding the Severe Pain, Where it Comes From, and How to Treat It

Sometimes when people describe headaches, they are actually describing facial pain. While there are a number of different types of facial pain syndromes, the most common one is trigeminal neuralgia.

Woman in grayscale holding her jaw with her hand and cheek highlighted in red to illustrate pain
Denis Kartavenko / Getty Images

Although still rare in occurrence, trigeminal neuralgia affects the trigeminal nerve—a nerve that provides sensation to the face and helps control jaw movement.

If you have trigeminal neuralgia, you know better than anyone else, the tremendous, sudden, and electric-shock-like pain this disorder causes. Let's dive a bit deeper into the "why" behind this pain condition, and how it can be treated.

Trigeminal Nerve

The trigeminal nerve is cranial nerve five (out of 12). It sends sensory information from the face to the brain and also helps control the muscles of chewing.

The trigeminal nerve has three major branches:

  • Ophthalmic (near the eye)
  • Maxillary (cheek-area)
  • Mandibular (jaw-area)

The branches of the trigeminal nerve most commonly affected in trigeminal neuralgia are the maxillary or mandibular branch. This is why people with trigeminal neuralgia commonly complain of tooth pain and even undergo painful and expensive dental procedures before being correctly diagnosed.

While trigeminal neuralgia can occur in both males and females, it is more common in females, and the disorder does not tend to run in families (meaning there is not a strong genetic component).

Understanding the Pain of Trigeminal Neuralgia

The pain of trigeminal neuralgia comes on abruptly, lasting one to many seconds. The pain is often described as intensely sharp, stabbing, or "electric shock-like." This disorder almost always affects one trigeminal nerve (you have a trigeminal nerve on each side of your face), but it can rarely affect both.

Causes of Trigeminal Neuralgia

Most cases of trigeminal neuralgia are caused by compression of the trigeminal nerve root, usually by an abnormal loop of an artery or vein in the face. Less commonly, compression of the trigeminal nerve may occur from a cyst or tumor, like an acoustic neuroma or meningioma. Inflammation of the nerve, like that which occurs in multiple sclerosis, can also cause trigeminal neuralgia.

Triggers of Trigeminal Neuralgia

It's common for certain activities to trigger the attacks of pain.

Examples of such triggers include:

  • Chewing
  • Brushing your teeth
  • Smiling
  • Talking or laughing
  • Shaving
  • Exposure of your face to cold air
  • Light touching of the face

Diagnosis of Trigeminal Neuralgia

Your primary care physician or neurologist will make the diagnosis. Often brain imaging (like a brain MRI) is needed to rule out secondary causes like a tumor or multiple sclerosis first. Other conditions that can mimic trigeminal neuralgia include:

Treatment of Trigeminal Neuralgia

Treatment is usually with an anti-seizure medication called Tegretol (carbamazepine). While often effective, it does carry some potential adverse effects (especially with higher doses, which some people may need over time).

Some of these adverse effects include:

  • Drowsiness
  • Dizziness
  • Nausea
  • Vomiting

Some people develop a low number of white blood cells (infection-fighting cells) on carbamazepine. Rarely, a person may develop aplastic anemia—a disorder that affects your bone marrow where blood cells are produced.

In addition, certain individuals, especially people of Asian descent who carry a certain genetic marker, may be at an increased risk of developing a potentially fatal skin disorder called Stevens-Johnson syndrome and/or toxic epidermal necrolysis. If you are of Asian ancestry, your doctor will most likely test you for this gene before prescribing carbamazepine.

Your doctor may consider other medications, like Trileptal (oxcarbazepine) which is similar in structure to carbamazepine and may have fewer side effects. If you have pain despite carbamazepine or oxcarbazepine (or cannot take or tolerate one of these drugs), a doctor may prescribe the muscle relaxant, baclofen or another medication called Lamictal (lamotrigine), which is used to treat seizures and bipolar disorder.

If you continue to suffer from trigeminal neuralgia despite optimal medical therapy, or if you cannot tolerate the side effects of medications, your neurologist may refer you for surgery. The good news is that there are a number of surgical procedures available. That being said, it's still surgery and carries risks, so requires a careful discussion with your neurologist and surgeon.

A Word From Verywell

If you are diagnosed with trigeminal neuralgia, be hopeful and ensure you follow closely with your neurologist. While this neurological disorder may not be able to be cured, you can effectively manage it and move forward with your life. 

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