Trigeminal neuralgia

Trigeminal neuralgia is a painful condition affecting one of the nerves in your face.

Key points

  1. It causes sudden, severe attacks of electric shock-like pain to your face. 
  2. The exact cause of trigeminal neuralgia is not known but it is thought to be caused by compression of the trigeminal nerve. 
  3. Symptoms include pain attacks that are sharp, electric shock-like or shooting that can last for a few seconds to about 2 minutes.
  4. The pain attacks can be triggered by certain actions or movements, eg, eating, smiling, chewing, talking, brushing your teeth or shaving. 
  5. There is no test to diagnose trigeminal neuralgia.
  6. The condition is usually treated by an anticonvulsant medicine called carbamazepine and avoiding things that trigger your symptoms. 

What are the causes of trigeminal neuralgia?

The trigeminal nerve (fifth cranial nerve) is one of the main nerves that supply your face. There is one on each side of your face.

They transmit pain and touch signals to your brain and control your jaw's muscle movements and the production of saliva and tears.

Each trigeminal nerve has 3 small branches:

  • first or ophthalmic branch – this supplies your scalp, forehead and around your eye
  • second or maxillary branch – this supplies your cheek
  • third or mandibular branch – this supplies the area around your jaw. 

The exact cause of trigeminal neuralgia is not known but is thought to be caused by the compression of the trigeminal nerve. It then carries faulty messages to your brain and causes electric shock-like pain to your face.

The trigeminal nerve can be compressed or injured by:

  • a blood vessel such as an artery or a vein – this is the most common cause
  • a tumour or a cyst
  • degenerative nerve condition such as multiple sclerosis
  • facial injury
  • surgery or dental procedures. 

People who are at higher risk of trigeminal neuralgia include:

What are the symptoms of trigeminal neuralgia?

Common symptoms of trigeminal neuralgia include:

  • electric shock-like pain on one side of your face, although sometimes it may also affect both sides 
  • pain that comes in sudden attacks that last for a few seconds to about 2 minutes, and can happen multiple times a day 
  • minutes, hours or days between each attack
  • pain that can be around your jaw or cheek or in your teeth
  • pain that is sharp, electric shock-like, shooting, stabbing, piercing or knife-like
  • pain that is so severe and excruciating that it affects your daily life
  • a dull ache or burning feeling in between the pain attacks.

See your GP or doctor if you have any of the symptoms above. 

What are the triggers of trigeminal neuralgia?

The pain attacks in trigeminal neuralgia can be triggered by certain actions or movements.

Examples of actions or movements that trigger trigeminal neuralgia:
  • chewing
  • eating
  • drinking hot or cold liquids
  • brushing teeth
  • washing face
  • shaving
  • putting on make-up
  • smiling
  • talking
  • swallowing
  • smoking
  • head movements
  • vibrations
  • blowing your nose
  • smiling
  • kissing
  • a light touch on your face
  • cool breezes
  • certain medicines
  • drug and alcohol use.

Sometimes you may not have a trigger for the pain attacks.

How is trigeminal neuralgia diagnosed?

Your doctor will ask you questions related to your pain, including the pattern and location of your pain. Your doctor will also examine your face, including your ear, nose, throat, head and jaw.

There is no test to diagnose trigeminal neuralgia. It is diagnosed through your history and by ruling out other conditions. Blood tests may be needed as a baseline if your doctor is going to prescribe medicines. Sometimes, your doctor will also advise doing an MRI scan to find out the cause.

How is trigeminal neuralgia treated?

Trigeminal neuralgia can be treated in different ways depending on how bad the pain is and whether the cause is known

Carbamazepine is most commonly used to treat trigeminal neuralgia. This is medicine that is used to treat epilepsy, but can also be used to treat nerve pain. Read more about carbamazepine.

Other medicines that may be prescribed include:

It can also help to identify and avoid triggers that are causing your pain, eg, if hot or cold drinks seem to be a trigger, you can try using a straw. 

In rare cases where medicines are unable to control the pain, surgery will be considered. Talk to your GP or doctor to find out the best treatment options for you. 

Botox injections have been tried, though there is not yet good evidence of its effectiveness.

What is the outlook for someone with trigeminal neuralgia?

Trigeminal neuralgia varies from person to person. Episodes may last for weeks or months. This can be followed by pain-free intervals of weeks to years, although most remissions only last for a few months.

It's common for the condition to recur (come back). Some people find that the condition tends to come and go in terms of how severe it is and how often the pain flares up. 

What support is available with trigeminal neuralgia?

People living with trigeminal neuralgia can feel distressed and have reduced quality of life. Talk through your feelings with your family/whānau and friends to get the support you need. You can also join a support group that shares information about trigeminal neuralgia such as Trigeminal Neuralgia New Zealand

Learn more

The following links provide further information about trigeminal neuralgia. Be aware that websites from other countries may have information that differs from New Zealand recommendations.

Trigeminal neuralgia HealthInfo Canterbury, NZ
Trigeminal neuralgia Health Direct, Australia 
Trigeminal neuralgia Patient Info, UK
Trigeminal neuralgia NHS, UK 

References

  1. Trigeminal neuralgia Auckland Regional HealthPathways, NZ 
  2. Trigeminal neuralgia Patient Info, UK

Reviewed by

Dr Helen Kenealy is a geriatrician and general physician working at Counties Manukau DHB. She has a broad range of interests and has worked in a variety of settings including inpatient rehabilitation, orthgeriatrics and community geriatrics.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Helen Kenealy, geriatrician and general physician, Counties Manukau DHB Last reviewed: 31 Aug 2020