Brain & Nervous System Headaches Symptoms Overview of Trigeminal Neuralgia Understanding the Severe Pain, Where it Comes From, and How to Treat It By Colleen Doherty, MD Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis. Learn about our editorial process Colleen Doherty, MD Medically reviewed by Medically reviewed by Claudia Chaves, MD on August 14, 2020 Claudia Chaves, MD, is board-certified in cerebrovascular disease and neurology with a subspecialty certification in vascular neurology. Learn about our Medical Review Board Claudia Chaves, MD Updated on September 17, 2020 Print 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. 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: ChewingBrushing your teethSmilingTalking or laughingShavingExposure of your face to cold airLight 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: Acute herpes zoster (shingles)Postherpetic neuralgiaTrauma to the trigeminal nerveDental-related painA headache disorder, such as primary stabbing headache 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: DrowsinessDizzinessNauseaVomiting 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. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Bajwa ZH, Ho CC, Khan SA. (2018). Trigeminal neuralgia. Shefner JM, Swanson JW, eds. UpToDate. Waltham, MA: UpToDate Inc. Gronseth G, Cruccu G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology. 2008;71:1183-1190. doi: 10.1212/01.wnl.0000326598.83183.04 Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 3rd Edition (beta version). Cephalalgia 2013;24(9):629-808. doi: 10.1177/0333102413485658 Zakrzewska JM, Linksey ME. Trigeminal neuralgia. BMJ. 2014 Feb 17;348:g474. doi: 10.1136/bmj.g474