Trigeminal Neuralgia: Symptoms, Causes & Treatment

Trigeminal neuralgia is a disorder of the trigeminal nerve that causes sudden, intense, electric shock-like pain in the face. The pain may be triggered by simple activities, such as touching the face, chewing, talking, smiling, or brushing the teeth.

Trigeminal neuralgia usually affects one side of the face and pain episodes often last from a few seconds to a few minutes. The condition is most commonly caused by pressure on the trigeminal nerve, but it can also be linked to multiple sclerosis, brain injuries, or other conditions that affect the nerves.

Although there is no cure for trigeminal neuralgia, treatment can help control pain and improve quality of life. Treatment usually starts with medication, while physical therapy or surgery may be recommended when symptoms are severe or do not improve with medication.

Trigeminal neuralgia symptoms

The main symptoms of trigeminal neuralgia are:

• Episodes of intense facial pain, usually extending from the corner of the mouth to the jaw

• Sudden, shock-like facial pain, even with slight movements

• Tingling in the cheeks

• A warm feeling in the cheeks, along the path of the nerve

According to the National Institute of Dental and Craniofacial Research, these episodes can be triggered by light touch, brushing the teeth, eating, drinking, talking, or exposure to cold air.

Trigeminal neuralgia pain usually lasts a few seconds or minutes. The pain can be very intense, affecting just one area or spreading across the face.

Confirming a diagnosis

Trigeminal neuralgia is diagnosed by a primary care provider or neurologist based on the person’s symptoms and the location of the pain.

Additional tests, such as an MRI or X‑ray, are often ordered to check whether a more serious problem is causing trigeminal neuralgia. These tests can help identify issues like a dental infection, a tooth fracture, or a tumor, for example.

Possible causes

Trigeminal neuralgia is usually caused by pressure on the trigeminal nerve. This most often happens when a nearby blood vessel shifts position and begins to press against the nerve.

However, this condition can also occur in people with brain injuries or autoimmune diseases that affect the nerves, such as multiple sclerosis. In these cases, the myelin sheath of the trigeminal nerve may wear down, causing the nerve to malfunction.

Common triggers

Trigeminal neuralgia symptoms can be triggered by any movement that causes nerve compression, such as brushing the teeth, chewing, smiling, talking, washing the face, or brushing the teeth.

Trigeminal neuralgia treatment

The main treatment options for trigeminal neuralgia include:

1. Medications

Medication is usually the first treatment recommended by a neurologist. Options that may be prescribed include:

• Anticonvulsants, such as carbamazepine, gabapentin, or lamotrigine

• Muscle relaxants, such as baclofen

• Antidepressants, such as amitriptyline or nortriptyline

According to NICE, carbamazepine is the drug of choice for treating trigeminal neuralgia, and specialist advice may be needed if it does not work, causes difficult side effects, or cannot be taken.

Trigeminal neuralgia causes strong facial pain that can feel like an electric shock. Medication is usually used to control nerve irritation and reduce symptoms.

2. Physical therapy

In some cases, physical therapy may include electrical stimulation, which uses small electrical impulses to help reduce pain. Although it may provide symptom relief for some people, it is not a standard treatment for trigeminal neuralgia.

3. Surgery

Surgical treatment for trigeminal neuralgia may be recommended when medication does not work or when pain is very severe. Surgery can be done in three ways:

• Glycerol injection into the branches of the trigeminal nerve in the face to block nerve function

• Radiofrequency ablation, which uses heat to damage part of the trigeminal nerve and relieve facial pain

• Surgery to remove a tumor or blood vessel that is putting pressure on the trigeminal nerve

Another technique is balloon compression. In this procedure, a small balloon is inflated near the trigeminal nerve root for about 1 minute to compress the nerve and reduce pain signals.

4. Home remedies

In some cases, trigeminal neuralgia pain may also be relieved with simple measures, such as placing a towel soaked in warm water over the back of the neck to help reduce nerve inflammation.

Another home remedy sometimes mentioned for trigeminal neuralgia is applying cayenne pepper mixed with olive oil or unscented face cream to the affected area. However, this is not an FDA-approved treatment for trigeminal neuralgia and should not be used unless recommended by a healthcare provider, as it may irritate the skin, eyes, or mucous membranes.