What Is Trigeminal Neuralgia, and How Is It Treated?

Trigeminal neuralgia is a condition that causes a stinging or burning pain in the face. It is sometimes described as feeling like an electric shock. It is more common in people over age 50 and in females. Trigeminal neuralgia is a chronic condition, which means it can last for a long time. But there are many treatment options available to help ease the pain. 

Read on to learn more about how trigeminal neuralgia can affect you and the different ways you can treat it.

How do you get trigeminal neuralgia?

Trigeminal neuralgia often starts when a blood vessel, tumor, or cyst presses on part of a nerve in your face called the trigeminal nerve. This important nerve sends sensations of touch and temperature from your face to your brain. Trigeminal neuralgia can also be caused by injury to the nerve, such as during a surgical procedure or an accident. 

There are also some medical conditions that can cause trigeminal neuralgia. One example is multiple sclerosis (MS), a disease that causes damage to the outer covering of nerves. When MS affects the trigeminal nerve, it can cause trigeminal neuralgia. 

Sometimes, the underlying cause of trigeminal neuralgia is unknown.  

Trigeminal neuralgia symptoms

There are two types of trigeminal neuralgia, and each has slightly different symptoms. In both types, people experience pain on one side of the face or mouth. Occasionally, the pain can affect both sides of the face.

Here’s how the type of pain differs between type 1 and type 2 trigeminal neuralgia:

• Type 1 trigeminal neuralgia is the more common type. People usually experience a sharp, stabbing, stinging, or shock-like pain that lasts a few seconds or minutes at a time. 

• Type 2 trigeminal neuralgia is the less common type. People with type 2 trigeminal neuralgia have a more constant, burning pain. 

Early on in the disease, it is common to have occasional episodes of pain which then settle. Over time, episodes can happen more often. In some people, even those with type 1 trigeminal neuralgia, the pain is nearly constant.

What can trigger trigeminal neuralgia?

If you've had episodes of trigeminal neuralgia before, you'll probably want to know how to stop them from coming again. Some common triggers of trigeminal neuralgia include:

• Touching the face

• Washing or shaving the face

• Brushing teeth

• Air movement against the face, such as with wind or air conditioning

• Certain foods that are hot, cold, spicy, or acidic

• Talking

In some cases, the pain may seem to happen without any trigger. 

Diagnosing trigeminal neuralgia

First, your healthcare provider will ask about your symptoms and do a physical exam. They will need to make sure that something else isn’t causing your pain, like temporomandibular joint dysfunction (pain in the jaw joint and muscles) or post-herpetic neuralgia (pain that lasts in an area after a shingles infection). Most people have an MRI done to find out if anything is pressing on the nerve, like a cyst, blood vessel, or tumor. An MRI can also be used to check for other conditions like multiple sclerosis.

What are the treatment options for trigeminal neuralgia?

The first step to treating trigeminal neuralgia is to treat the underlying cause — if possible. For example, if a tumor is pressing against the nerve, then it needs to be removed surgically. 

Where possible, avoiding behaviors and situations that can trigger trigeminal pain is key for managing and preventing symptoms.

Your healthcare provider can help you decide the best treatment options for your symptoms.

Medications: 

Medications that can reduce the pain of trigeminal neuralgia are one of the main treatment options. These include:

• Anticonvulsants or anti-epileptics like carbamazepine and oxcarbazepine, which are the most commonly used medications to treat trigeminal neuralgia pain.

• Muscle relaxants, such as baclofen, may be combined with carbamazepine to reduce pain. 

• Tricyclic antidepressants, such as amitriptyline and nortriptyline, are used to treat different types of nerve pain.

• Botulinum toxin A: This drug is injected into the area of the trigeminal nerve and can also be helpful for reducing pain in some people.

When the pain becomes more frequent or severe, different doses, types, or combinations of medication may be needed. Over-the-counter pain medicines like acetaminophen, ibuprofen, and aspirin don’t usually work for trigeminal neuralgia. Opioid medications are generally not effective, either. 

Acupuncture

This ancient technique has been shown to be effective in reducing the pain of trigeminal neuralgia with minimal side effects. 

Surgery 

If medications no longer work, or if pain episodes are frequent and severe, your healthcare provider may recommend one of the different surgical procedures used to treat trigeminal neuralgia.

• Rhizotomy: Different procedures may be used to damage nerve fibers in order to block pain. This may be done by injecting a chemical into the nerve or using heat, electricity, or radiation.

• Neurectomy: During this type of procedure, the trigeminal nerve is either surgically cutting or partially removed. 

• Microvascular decompression: For cases where a blood vessel is pressing on the trigeminal nerve, a small cushion is placed between the nerve and the blood vessel that is pressing on it.

Surgical procedures used to treat trigeminal neuralgia can completely eliminate pain in many cases. But these types of procedures may cause issues like numbness of the face and are usually used as a last resort. 

Can trigeminal neuralgia be cured?

Without treatment, trigeminal neuralgia may not completely go away for everyone. But many people with trigeminal neuralgia can have pain-free periods of time lasting up to weeks and even years at a time. Cure rates of up to 95% are reported with certain surgical procedures, but even in those cases, the pain can reoccur. 

Is trigeminal neuralgia serious?

The condition itself is not life-threatening, but it can affect a person’s quality of life. The pain of trigeminal neuralgia can limit your ability to eat, drink, bathe, brush teeth, or be with family and friends. Because episodes of pain occur more often over time, trigeminal neuralgia can also affect your mental health. For some people, this can lead to depression or isolation. 

If you have trigeminal neuralgia and are experiencing any mental health symptoms, reach out to your healthcare provider right away.

Why trust our experts?

Written by:

Anne Jacobson, MD, MPH

Anne Jacobson, MD, MPH has been a board-certified family physician since 1999. She worked as a full-scope family physician (inpatient, outpatient, obstetrics, and office procedures) in the Cook County Ambulatory Health Network for 15 years.

Edited by:

Aunna Pourang, MD

Aunna Pourang, MD, graduated from the University of Florida College of Medicine’s Medical Honors Program and is board-certified in family medicine (Mayo Clinic). She is also fellowship-trained in integrative medicine (Academy of Integrative Health and Medicine).

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