Trigeminal Neuralgia

If you experience sudden, sharp bursts of pain in your cheek or jaw, you may have trigeminal neuralgia. This nerve condition can make daily activities like eating, talking or brushing your teeth unbearable.

Even though the pain can be intense, relief is possible. At Banner Brain & Spine, our neurology and pain specialists can help you find ways to manage your symptoms and improve your quality of life. 

What is trigeminal neuralgia?

Trigeminal neuralgia (TN) is a chronic (long-term) nerve condition that affects the trigeminal nerve (or cranial nerve V). This nerve sends signals between your face and brain and controls sensations and movement in your jaw and facial muscles.

When this nerve is irritated or damaged, even gentle touches – like wind on your cheek or a light brush with your fingers – can cause severe pain. These attacks may come and go without warning or happen many times a day. Most cases affect just one side of the face, but TN is more common in women and people over 50. It is very rare in children. 

Trigeminal neuralgia is sometimes called tic douloureux, meaning “painful tic” because of the facial twitches the pain may cause.

What does trigeminal neuralgia feel like?

Trigeminal neuralgia can feel different for everyone. Some describe it as:

• Feeling like an electric shock
• Sharp, stabbing or shooting pain
• Brief bursts of pain that last seconds or minutes
• Tingling, aching or numbness between attacks

The pain may affect your cheek, jaw, teeth and gums. Some people also feel it on their lips, nose, eyes, ears or forehead. In nearly all cases, it happens on just one side of the face. 

Over time, pain attacks can become more frequent and intense, lasting days or weeks and multiple times a day. Because of this, TN can greatly affect your mental health. People with TN are at greater risk for anxiety, depression and social isolation.

Conditions that can be confused with trigeminal neuralgia

Because TN causes facial pain, it’s sometimes confused with other problems, such as:

• Dental problems, like a tooth abscess or a cracked tooth
• Temporomandibular joint disorder (TMJ)
• Sinus infections
• Cluster headaches
• Shingles or postherpetic neuralgia
• Migraines 

If you’ve had facial pain that doesn’t go away or keeps coming back, talk to your health care provider.

What causes trigeminal neuralgia?

TN develops when the trigeminal nerve is compressed, irritated or damaged. Common causes include:

• Nerve compression: A blood vessel pressing on the nerve near the brainstem can cause irritation
• Multiple sclerosis (MS): MS can damage the nerve’s protective coating (myelin)
• Tumors or cysts: Rarely, growths near the nerve can trigger symptoms 
• Injury or trauma: Facial or dental surgery, stroke or head injuries may damage the nerve 
• Aging: Natural changes in nerves or blood vessels can increase risk

Sometimes, there is no clear cause. This is called idiopathic trigeminal neuralgia.

Types of trigeminal neuralgia

There are two main forms of TN:

Classic trigeminal neuralgia (type 1)

Classic TN is the most common type. It’s typically caused by a blood vessel pressing on the trigeminal nerve. 

Symptoms include:

• Sudden, severe, shock-like pain
• Attacks that come and go in short bursts
• Pain triggered by things like eating, drinking, speaking, shaving or brushing your teeth

Atypical trigeminal neuralgia (type 2)

Atypical TN causes more constant discomfort and can be harder to diagnose.

Symptoms may include:

• Ongoing burning, aching or stabbing pain
• Fewer sharp, electric-like jolts
• Pain that is less intense but more persistent 

Some people may experience both types of pain at the same time.

How trigeminal neuralgia is diagnosed

Diagnosing TN starts with a detailed medical history and physical exam. Your provider may ask questions like:

• Where and how often do you feel pain?
• What does the pain feel like?
• What triggers it?
• How long does it last?
• What helps relieve it?

You may also have tests to rule out other causes. These may include:

• Magnetic resonance imaging (MRI) scan to check for nerve compression, tumors or signs of MS
• Neurological exam to check facial sensations, muscle strength and reflexes

Banner Brain & Spine specialists are experienced in identifying trigeminal neuralgia and ruling out other causes of facial nerve pain.

Treating trigeminal neuralgia

There is no cure for TN. It is a long-term condition that doesn’t go away on its own, but many people find relief through medication, procedures or surgery. Your care team will create a plan that fits your needs and goals. 

Medications

Many people start with medication to reduce or block pain signals from the nerve. Your provider may adjust the dose or type over time.   

Common options include:

• Anti-seizure medicines (anticonvulsants), such as carbamazepine or oxcarbazepine
• Muscle relaxants, such as baclofen
• Tricyclic antidepressants, which may help with burning or constant pain

Advanced surgical procedures

If medications stop working or cause side effects, your provider may suggest a procedure. These treatments aim to reduce or block pain signals from the nerve.

Minimally invasive options:

• Nerve blocks: Temporary pain relief with injections near the nerve
• Glycerol injection: A chemical that destroys part of the nerve to reduce pain
• Balloon compression: Uses a balloon to compress the nerve
• Rhizotomy: Intentionally damages part of the trigeminal nerve to stop pain

Non-invasive option:

• Stereotactic radiosurgery (CyberKnife or Gamma Knife treatment): Focused radiation targets the nerve without incisions (cuts) 

Surgical option:

• Microvascular decompression (MVD): A neurosurgeon moves the blood vessel pressing on the nerve and places a small cushion to protect it. This procedure offers long-lasting relief without damaging the nerve.

Like any procedure, surgical treatments for TN have some risks. These may include infection, facial numbness or failure to relieve pain. Your provider will discuss the possible benefits and risks of each option to help you decide what’s right for you.

Complementary and integrative therapies

These supportive therapies may not replace other treatments, but they can help manage symptoms and improve well-being: 

• Botulinum toxin (Botox): Botox injections may reduce nerve signals causing pain.
• Acupuncture: This traditional Chinese medicine technique uses fine needles to stimulate pressure points and promote natural pain relief.
• Biofeedback: This technique helps you learn to control body functions, like muscle tension or heart rate, that may contribute to pain.
• Cognitive behavioral therapy: Living with chronic pain can be emotionally difficult. Therapy can help you manage stress, anxiety or depression that may worsen symptoms.
• Support groups: You may find encouragement and understanding in a group of people experiencing what you are going through. 
• Yoga, meditation and deep breathing: These mind-body practices can lower stress, relax muscles and support the nervous system. 

Talk to your health care provider before starting any new therapy. 

Living with trigeminal neuralgia

TN can be difficult to live with but many people find ways to manage it. With a proper treatment plan, you may reduce pain and regain control of your daily life. 

You may still have occasional flare-ups but many people find relief and return to activities they enjoy. Support from your care team and others who understand can make a big difference.

When to see a health care specialist

You should talk to a health care provider if:

• You have sudden, sharp or shooting facial pain
• Over-the-counter (OTC) pain relievers aren’t helping
• Your symptoms affect daily life
• You’ve been diagnosed with TN but need more treatment options

How Banner Brain & Spine can help

At Banner Brain & Spine, we understand the impact facial nerve pain can have on your life. Our team of neurologists, neurosurgeons and pain specialists offer personalized, expert care using the latest diagnostic tools and advanced procedures.

Whether you’re newly diagnosed or looking for better symptom control, we’re here to help. Schedule an appointment today.