What Is Trigeminal Neuralgia? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Trigeminal neuralgia is a chronic pain disorder caused by dysfunction of the trigeminal nerves, which provide feeling to much of your head and face, including your mouth and teeth.

People with trigeminal neuralgia tend to experience sudden and severe episodes of facial pain, usually on one side of the face. These attacks can last a few seconds to a couple of minutes, and may occur regularly for days or weeks or even longer. Attacks may be triggered by stimulation to your face, such as talking or eating.

While trigeminal neuralgia can occur at any age, it’s more common in people ages 50 and older. It’s also more common in women than in men, according to the National Institute of Neurological Disorders and Stroke (NINDS). Certain health conditions can cause trigeminal neuralgia, including multiple sclerosis or a tumor that causes nerve compression.

Trigeminal neuralgia is diagnosed based on your symptoms and medical history, along with physical and neurological examinations. As part of the diagnostic process, it’s important to rule out other conditions that can cause facial pain, which may involve tests for those conditions.

Treatment for trigeminal neuralgia may include medications, surgery, or other approaches to help reduce pain and avoid attacks. It’s important to seek out effective pain relief and to try a different treatment if your current approach isn’t giving you the relief you need.

Trigeminal neuralgia is also known as tic douloureux, from the French term meaning “painful tic,” or spasm.

Signs and Symptoms of Trigeminal Neuralgia

Pain from trigeminal neuralgia often begins in your upper or lower jaw, which may lead to an initial assumption that the pain is dental-related, according to the American Association of Neurological Surgeons (AANS). Pain may be focused in one spot, or it may spread throughout your face — typically just on one side, but not always. You may have facial spasms in addition to pain.

Most often, trigeminal neuralgia occurs in cycles consisting of days to weeks of frequent attacks, followed by weeks, months, or years with little to no pain. But over time, attacks tend to become more intense, and periods without attacks or pain tend to become shorter.

Pain or other sensations from trigeminal neuralgia may have any of the following qualities:

  • Shooting or stabbing pain
  • Burning sensation
  • Electric shock sensation
  • Aching sensation
  • Tingling sensation or numbness

Trigeminal neuralgia falls in two broad categories based on the type of pain it causes. Type 1, or TN1, tends to involve shorter episodes of intense pain, while type 2, or TN2, involves ongoing pain that is usually less severe than in TN1, NINDS notes.

Type 1 (TN1)

TN1 is considered to be the “classic” form of trigeminal neuralgia, since it’s more common than TN2. It involves episodes of extreme facial pain — which may feel like an electric shock or a burning sensation — that come on suddenly and generally last a few seconds to a couple of minutes. These attacks often occur frequently for up to 2 hours at a time. Attacks of TN1 rarely happen during sleep.

Type 2 (TN2)

TN2 is considered to be the “atypical” form of trigeminal neuralgia, and involves constant facial pain that may feel like aching, burning, or stabbing. This pain is typically less severe than in TN1.

TN1 may also develop into progressive trigeminal neuralgia, meaning that attacks get worse and more frequent over time. Eventually, the pain may become constant, and medications to control it may become less effective, according to NINDS.

Causes and Risk Factors of Trigeminal Neuralgia

Trigeminal neuralgia involves dysfunction of at least one of your trigeminal nerves, a pair of nerves that run from your brain to each side of your head. Each of these nerves has three branches, as outlined by AANS:

  • Ophthalmic Nerve This nerve branch provides feeling on each side to your eye, upper eyelid, and forehead.
  • Maxillary Nerve This nerve branch provides feeling on each side to your lower eyelid, cheek, nostril, upper lip, and upper gum.
  • Mandibular Nerve This nerve branch provides feeling on each side to your jaw, lower lip, and lower gum.

Depending on how your trigeminal nerve is affected, you may experience pain in any or all of these areas of your head and face.

Trigeminal neuralgia can be either classical, accounting for 75 percent of cases; secondary, accounting for 15 percent; or idiopathic, accounting for 10 percent. In all cases, something causes irritation to your trigeminal nerve, causing it to misfire and improperly send pain signals to your brain.

Classical trigeminal neuralgia is defined by the International Headache Society (IHS) as “developing without apparent cause other than neurovascular compression.” It is often linked to compression of your trigeminal nerve, especially at the base of your head where your brain connects to your spinal cord. This compression is usually due to a healthy blood vessel placing pressure on the nerve.

“It’s a very crowded area back around the brain stem, with a lot of blood vessels and exiting cranial nerves, including the trigeminal nerve,” explains Devon Conway, MD, a neurologist at the Cleveland Clinic in Ohio. “If the vascular structure is pushing against the nerve, it can cause this dysfunction and trigger the pain.”

Secondary trigeminal neuralgia is TN caused by another condition. It may occur due to compression of your trigeminal nerve by a tumor or cyst, or due to a facial injury or surgery, a stroke, or damage to the nerve’s protective myelin sheath by multiple sclerosis (MS) or another demyelinating disease.

Idiopathic trigeminal neuralgia is defined by the IHS as cases “with neither electrophysiological tests nor MRI showing significant abnormalities.” In other words, no underlying cause can be identified.

In people with MS, damage to the nerve’s myelin sheath can occur “in the area where the trigeminal nerve is in the brain stem structure, known as the pons, then that can trigger pain,” Dr. Conway notes.

Nearly any kind of stimulation to your face can set off an attack of trigeminal neuralgia in someone with the condition, often inconsistently or unpredictably. Potential triggers for attacks include the following, according to Mayo Clinic:

  • Talking
  • Smiling
  • Touching your face
  • Eating or drinking
  • Washing your face
  • Shaving
  • Applying makeup
  • Brushing your teeth
  • Feeling wind on your face

Trigeminal neuralgia is more common in people ages 50 and older, although it can occur as young as infancy, NINDS notes. It’s more common in women than in men, for reasons that aren’t fully understood.

How Is Trigeminal Neuralgia Diagnosed?

As part of the process of diagnosing trigeminal neuralgia, your doctor will take note of your symptoms and medical history. It’s likely that your doctor will screen for other health conditions that can cause facial pain before diagnosing trigeminal neuralgia, which may include the following conditions, according to AANS:

  • Postherpetic neuralgia
  • Cluster headaches or migraine
  • Temporomandibular joint syndrome (TMJ)
  • Temporal tendonitis
  • Ernest syndrome
  • Occipital neuralgia
  • Giant cell arteritis
  • Glossopharyngeal neuralgia
  • Sinus infection
  • Ear infection
  • Dental pain

If other conditions are ruled out and your doctor suspects trigeminal neuralgia, you may undergo magnetic resonance imaging (MRI) to look for signs of MS or a tumor that could be causing your pain. It’s possible — but not guaranteed — that a regular MRI scan could show a blood vessel compressing your trigeminal nerve if that is the source of your pain, NINDS notes.

If initial MRI results don’t show conclusively what’s causing your trigeminal neuralgia, you may undergo a specialized MRI to look for a blood vessel compressing your trigeminal nerve.

Your doctor may also give you a neurological examination to help diagnose your condition. This involves examining parts of your face to help determine exactly where your pain is occurring, and what nerve branch may be involved, Mayo Clinic notes.

To help confirm a diagnosis of trigeminal neuralgia — particularly TN1 — your doctor may prescribe a short course of an anticonvulsant (antiseizure) medication. If the drug relieves your pain, this supports a diagnosis of trigeminal neuralgia.

If your doctor suspects that you have TN2 based on your symptoms and other findings, you may be prescribed a short course of a tricyclic antidepressant to help confirm the diagnosis, according to NINDS.

Duration and Prognosis of Trigeminal Neuralgia

With or without treatment, pain from trigeminal neuralgia may become more frequent over time — sometimes to the point where periods without pain may be very short or even nonexistent, according to the Cleveland Clinic.

The intensity of your pain may also increase over time, which can make it more difficult or even impossible to do certain daily tasks that involve your face — the fear of triggering an attack may be too strong. Certain drug treatments or other pain relief techniques may also become less effective over time, making it necessary to change your approach to pain management.

It’s important to remember that many potentially effective treatments for pain from trigeminal neuralgia exist, and that the goal of treatment at any point in time is to find an approach that works for you. Even though you’ll never be completely free of the condition, the right approach can usually keep pain to a minimum.

Treatment and Medication Options for Trigeminal Neuralgia

The main treatments for trigeminal neuralgia are aimed at pain relief, and involve drugs and surgical procedures. You may also be able to help cope with or relieve pain from trigeminal neuralgia through certain mind-body techniques and other alternative treatments.

Medications

The most common first-line drug treatment for trigeminal neuralgia is carbamazepine (Tegretol), an anticonvulsant that is often prescribed to help prevent seizures. Other anticonvulsants that may be used to treat trigeminal neuralgia include the following, according to the Mayo Clinic:

  • oxcarbazepine (Trileptal)
  • lamotrigine (Lamictal)
  • phenytoin (Dilantin)
  • sodium valproate
  • gabapentin (Neurontin)
  • clonazepam (Klonopin)
  • topiramate (Qsymia)
  • pregabalin (Lyrica)

If the anticonvulsant you’re taking for trigeminal neuralgia starts to become less effective, your doctor may recommend switching to a different drug. Before you start taking carbamazepine, your doctor may recommend a genetic test to screen for a potentially serious reaction in some people.

Another type of drug that your doctor may prescribe is an antispasmodic drug, or muscle relaxant. This drug may be taken alone or in combination with an anticonvulsant, and the most common choice is baclofen (Lioresal).

Tricyclic antidepressants are another group of drugs that may be helpful to relieve pain in trigeminal neuralgia. The most commonly used drugs in this category are amitriptyline and nortriptyline, according to the Cleveland Clinic. These drugs are often used to treat TN2.

Other drugs that are less commonly used to treat trigeminal neuralgia include opioids — mainly for TN2 — and botulinum toxin (Botox) injections, which may be helpful when other medications no longer work effectively.

Surgery: Rhizotomy

Rhizotomy, also known as rhizolysis, involves intentionally damaging nerve fibers to block pain signals in trigeminal neuralgia. It always causes some loss of sensation and facial numbness, according to NINDS. There are a few different types of rhizotomy, all of which require either sedation or general anesthesia:

  • Balloon Compression This technique uses a small balloon at the end of a catheter (thin tube) to push part of your trigeminal nerve against your dura (thick membrane surrounding your brain and spinal cord) and skull, injuring the insulation of nerve fibers. This procedure can reduce the sensation of light touch on your face and relieve pain for one to two years.
  • Glycerol Injection This technique involves injecting a medication to damage the insulation of nerve fibers, and can also lead to pain relief for one to two years. This procedure may be repeated if necessary.
  • Radiofrequency Thermal Lesioning This technique uses an electrode to apply heat and damage nerve fibers. More than one instance of this procedure may be needed to achieve the desired level of pain relief. This relief may be permanent, although many people experience a return of pain within three to four years.

Other Surgical Procedures

As an alternative to rhizotomy, certain other procedures may be used to relieve pain in trigeminal neuralgia, according to AANS:

  • Stereotactic Radiosurgery This noninvasive procedure sends a concentrated beam of radiation to an area at the root of your trigeminal nerve. Over a period of weeks to months, a lesion forms that disrupts nerve signal transmission.
  • Neuromodulation This procedure involves placing electrodes under your skull, either on the covering of your brain or deeper into your brain. Electrical stimulation is then given to the part of your brain that’s responsible for sensation in your face.
  • Microvascular Decompression This is the most invasive type of surgery used to treat trigeminal neuralgia, and involves opening up your skull (craniotomy). Your surgeon will look for the area where a blood vessel is compressing your nerve, and move the blood vessel way from the area. Recovery may take several weeks, and pain relief may be permanent or last 12 to 15 years, according to NINDS.

Complementary and Alternative Treatments

Some people with trigeminal neuralgia find that certain lifestyle or nutritional practices help with pain relief — usually in combination with drug treatments. The following steps may help, according to NINDS:

  • Yoga and other low-impact exercises
  • Meditation
  • Creative visualization or guided imagery
  • Aromatherapy
  • Acupuncture
  • Chiropractic treatment
  • Biofeedback
  • Vitamin or nutritional therapy

Prevention of Trigeminal Neuralgia

Other than trying to avoid facial injury or trauma — which may cause secondary trigeminal neuralgia — there are no known ways to reduce the risk of developing trigeminal neuralgia. But you may be able to avoid painful attacks by avoiding certain activities that trigger them, and by getting effective treatment, according to the Cleveland Clinic.

Complications of Trigeminal Neuralgia

Trigeminal neuralgia is not life threatening, and it isn’t known to contribute to any other physical health conditions. But if you experience frequent attacks of pain, trigeminal neuralgia can seriously harm your quality of life and make it difficult to do everyday activities. It’s important to seek effective pain relief, and to consider a different treatment or approach whenever your current treatment isn’t giving you lasting relief.

Research and Statistics: How Many People Have Trigeminal Neuralgia?

Trigeminal neuralgia is a rare disease, with 10,000 to 15,000 new cases diagnosed each year in the United States, according to the National Organization for Rare Disorders (NORD). These cases occur mostly in adults ages 50 and older.

According to a research review published in The Journal of the American Dental Association, the proportion of women with trigeminal neuralgia may be anywhere from 0.03 percent to 0.3 percent. Men were found to be about one-third as likely to have the condition as women, and the age bracket with the greatest number of cases was 37 to 67 years old.

Trigeminal neuralgia may occur as a result of multiple sclerosis (MS), and one study found that 9.7 percent of people with MS in a North American registry had the condition. But not everyone received a diagnosis of trigeminal neuralgia before a diagnosis of MS — 15 percent were diagnosed with trigeminal neuralgia first. The average age at diagnosis of trigeminal neuralgia in this population was 45.3.

Related Conditions

Symptoms of several other conditions may be similar to those of trigeminal neuralgia, including the following ones, according to NORD:

  • Post-herpetic neuralgia
  • Cluster headaches or migraine
  • Temporomandibular joint syndrome (TMJ)
  • Occipital neuralgia
  • Giant cell arteritis
  • Glossopharyngeal neuralgia
  • Sinus infection
  • Ear infection
  • Dental pain

Trigeminal Neuralgia Resources

The following organizations offer in-depth information, support, and research opportunities for people living with trigeminal neuralgia and their families:

National Institute of Neurological Disorders and Stroke

This institute of the U.S. National Institutes of Health (NIH) offers information on trigeminal neuralgia treatments and research findings, and provides guidance on how to get involved in a clinical trial.

American Association of Neurological Surgeons

This professional organization for neurosurgeons gives an overview what’s happening in your body in trigeminal neuralgia, drugs and surgical treatments, and how to prepare for an appointment with a neurosurgeon.

Facial Pain Association

This organization serves people with neuropathic facial pain, and offers information on facial pain in general as well as specific disorders, help with navigating a diagnosis or treatments, and information on support groups and peer mentoring opportunities.

Facial Pain Research Foundation

This all-volunteer organization was founded to advance a cure and therapies for trigeminal neuralgia and related disorders. It states that 95 cents out of every dollar it raises goes directly toward research.

Additional reporting by Becky Upham.

Leave a comment

Your email address will not be published. Required fields are marked *