Trigeminal neuralgia

Overview

Trigeminal neuralgia is a condition that causes sudden, severe facial pain. The pain often feels like an electric shock or a sharp, stabbing sensation. It happens when the trigeminal nerve — the nerve that carries feeling from your face to your brain — is irritated or compressed.

Trigeminal neuralgia is not very common, but it is not extremely rare either. Estimates suggest it affects about 1 in 15,000 people each year.

It most often affects people over the age of 50 and is more common in women than in men. However, it can occur at any age, including in children.

Symptoms

Common symptoms

• Sudden, severe facial pain — often described as stabbing, electric shock-like, or shooting.
• Pain that comes and goes in waves, with pain-free intervals between attacks.
• Pain triggered by light touch, chewing, talking, brushing teeth, or even a gentle breeze.
• Pain usually on one side of the face, most often in the cheek, jaw, teeth, gums, or around the eye.

Symptoms in children

• Trigeminal neuralgia is rare in children, but when it occurs, the symptoms are similar to adults — sudden, severe facial pain on one side.
• Children may have trouble describing the pain, so parents should watch for signs like wincing, avoiding certain foods, or crying for no clear reason during eating or tooth brushing.

Symptoms in older adults

• In older adults, the pain episodes may be more frequent or longer lasting.
• Older adults are more likely to have other health conditions that can complicate treatment, so careful management with a doctor is important.

Causes

Main causes

• The most common cause is pressure on the trigeminal nerve from a nearby blood vessel. This is called neurovascular compression.
• Less often, the nerve is damaged by another condition, such as multiple sclerosis (a disease affecting the protective covering of nerves).
• Very rarely, a tumor or cyst pressing on the nerve can be the cause.

Risk factors

• Being over 50 years old.
• Being female.
• Having high blood pressure (hypertension).
• Having multiple sclerosis or other conditions that affect the nerves.

When to see a doctor

See a doctor urgently if:

• See a doctor urgently if you have severe facial pain that does not get better with over-the-counter pain relief (such as paracetamol or ibuprofen).
• If the pain stops you from eating, drinking, or sleeping, seek care the same day.

Book a routine appointment if:

• Make a routine appointment with your doctor if you have sudden, sharp facial pain that comes and goes, even if it is mild. Early diagnosis can help manage symptoms better.

Diagnosis

A doctor will diagnose trigeminal neuralgia by listening to your symptoms and performing a physical examination. They may ask about the type, location, and triggers of your pain. There is no single test for it, but other tests help rule out other causes.

Tests that may be done

• Neurological exam: The doctor will check your facial sensation, strength, and reflexes.
• Magnetic resonance imaging (MRI): A scan that uses magnets and radio waves to take detailed pictures of your brain and nerves. This can show if a blood vessel or other structure is pressing on the trigeminal nerve.

What to expect at your appointment

The diagnosis process may take a few appointments. Your doctor will likely refer you to a neurologist (a nerve specialist). You might need an MRI, but it is painless and usually takes about 30 minutes. The results help the team decide the best treatment for you.

Treatment

Treatment for trigeminal neuralgia aims to reduce or stop the pain attacks. It often starts with medications, and if those are not effective, other procedures or surgery can be considered. Your doctor will work with you to find the safest and most effective plan.

Self-care at home

• Avoid known triggers: For example, rest your face when chewing, use a soft-bristle toothbrush, and avoid very cold or very hot foods.
• Apply a cool cloth or an ice pack wrapped in a towel to the painful area for brief periods (10-15 minutes) to help numb the pain. Some people prefer warmth — try what feels best.
• Practice gentle relaxation techniques such as deep breathing or meditation to help manage pain-related stress.

Medical treatments

The main medical treatments are medications that calm overactive nerve signals. These include certain antiepileptic medicines (usually started at low doses and increased slowly) and muscle relaxants. Your doctor will prescribe the one that suits you best and monitor for side effects. In some cases, nerve blocks or injections can provide temporary relief. Always take medications exactly as prescribed.

When is surgery considered?

Surgery may be considered if medications do not work well or cause too many side effects. Common procedures include microvascular decompression — where a surgeon moves the blood vessel off the nerve — or Gamma Knife radiosurgery, which uses focused radiation to damage the part of the nerve causing pain. These are usually effective but carry some risks. Talk to your neurologist or neurosurgeon about the best option for you.

Living with this condition

Living with trigeminal neuralgia can be challenging, but many people learn to manage the pain. Keep a diary of your pain attacks to identify triggers. Plan your day to avoid stressful situations that might bring on pain. Let your family and friends know about your condition so they can support you.

Lifestyle tips

• Eat soft, easy-to-chew foods (like yogurt, soup, or mashed potatoes) when pain is bad.
• Use a straw for cold or hot drinks if the cup triggers pain.
• Wear a scarf or face mask in cold weather to protect your face from wind.

Diet and exercise

A balanced diet helps keep your body strong. If chewing is painful, choose nutrient-rich soft foods. Gentle exercise like walking or stretching can improve your mood and reduce stress. Avoid activities that involve sudden facial movements or strong winds on your face.

Mental health and emotional wellbeing

Living with chronic pain can be stressful and may lead to anxiety or depression. It is normal to feel frustrated or sad. Talk to your doctor if pain affects your mood. Counselling or support groups can also help.

Prevention

Trigeminal neuralgia cannot be prevented in most cases because it is often caused by a blood vessel pressing on a nerve, which is not something you can control. However, avoiding triggers can help prevent or reduce the number of pain attacks.

Vaccines

There is no vaccine for trigeminal neuralgia.

Screening programmes

There is no routine screening test for trigeminal neuralgia. If you have symptoms, see your doctor for an evaluation.

Complications

If left untreated

• Chronic (long-lasting) pain that can interfere with daily activities like eating, talking, and sleeping.
• Weight loss or dehydration due to avoiding food and drink because of pain.
• Depression, anxiety, or social withdrawal due to the stress of living with pain.

Long-term outlook

With proper treatment, most people with trigeminal neuralgia get significant relief from their pain. Medications work well for many, and if they don't, surgical options have a high success rate. Although it can be a long-term condition, many people learn to manage it and lead a full life. Your healthcare team will support you every step of the way.

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