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Trigeminal neuralgia (try-JEM-ih-nul nu-RAL-juh) is a condition that causes intense pain similar to an electric shock on one side of the face. It affects the trigeminal nerve that carries signals from the face to the brain. This nerve has three branches and supplies feeling to the cheek, jaw, teeth, gums, lips, eyes and forehead. Even light touch from brushing your teeth or putting on makeup may trigger a jolt of pain. Trigeminal neuralgia can be long-lasting. It's known as a chronic pain condition.

People with trigeminal neuralgia may have short, mild episodes of pain at first. But the condition can get worse, causing longer periods of pain that happen more often. It's more common in women and people older than 50.

But trigeminal neuralgia, also known as tic douloureux, doesn't mean living a life of pain. Treatment usually can help manage the condition.

Pain of trigeminal neuralgia affects certain areas of the face. It is triggered by common activities and described in similar ways. These patterns include

• Episodes of intense shooting or jabbing pain that may feel like an electric shock.
• Pain in areas supplied by the trigeminal nerve. These areas include the cheek, jaw, teeth, gums or lips. Less often, the eyes and forehead may be affected.
• Sudden episodes of pain or pain triggered by touching the face, chewing, speaking or brushing your teeth.
• Pain on one side of the face at a time.
• Pain focused in one spot. Or the pain may be spread in a wider pattern.

The pain you feel may happen at certain times or last a certain length of time. These patterns may include:

• Episodes of pain lasting from a few seconds to several minutes.
• Pain that happens with facial spasms.
• Episodes of pain lasting days, weeks, months or longer. Some people have periods when they experience no pain.
• Pain that rarely occurs while sleeping.
• Episodes of pain that become more frequent and intense over time.

When to see a doctor

See your healthcare team if you experience intense jolts of pain in your face, especially if it's long-lasting or comes back after going away. Also get medical attention if you have ongoing pain that doesn't go away with nonprescription pain medicine.

In trigeminal neuralgia, the trigeminal nerve doesn't work as it should. This may happen for different reasons. There are three different types of trigeminal neuralgia: Classic, secondary and idiopathic. For each type, there may be a different cause of the pain.

In classic trigeminal neuralgia, a blood vessel at the base of the brain presses on the trigeminal nerve. The pressure interrupts the function of the nerve causing pain. The blood vessel may be an artery or a vein. This is the most common type of trigeminal neuralgia.

Secondary trigeminal neuralgia may be caused by underlying health conditions or issues. For instance, conditions such as multiple sclerosis (MS) damage the protective covering of certain nerves known as the myelin sheath. When the myelin sheath is damaged, pain may be felt. Also, injury to the nerve during surgery or a tumor pressing against the trigeminal nerve can cause the condition. Or some people may experience trigeminal neuralgia after a stroke or facial trauma.

Idiopathic trigeminal neuralgia may be diagnosed if there is no clear cause of the pain. This is the least common type of trigeminal neuralgia.

Triggers

Several triggers may set off the pain of trigeminal neuralgia, including:

• Shaving.
• Touching your face.
• Eating.
• Drinking.
• Brushing your teeth.
• Talking.
• Putting on makeup.
• A light breeze blowing over your face.
• Smiling.
• Washing your face.

Your healthcare professional may diagnose trigeminal neuralgia mainly based on how you describe your pain. This person may ask you questions about your pain, including:

• Type. Pain caused by trigeminal neuralgia is sudden, intense and quick. It may feel like an electric shock. The pain may last for less than a second or up to two minutes.
• Location. Where you feel pain in your face can tell your care team if the trigeminal nerve is involved.
• Triggers. Eating, talking, a light touch or even a cool breeze on your face can bring on pain.

Your care team may do tests to help diagnose or find the cause of trigeminal neuralgia. Tests may include:

• A neurological exam. Touching and checking parts of your face can help your care team know where the pain is happening and which branch of the trigeminal nerve may be involved. Reflex tests can help show if your symptoms are caused by pressure on the nerve or another condition.
• MRI. You may need an MRI to look for possible causes of trigeminal neuralgia. An MRI may reveal signs of multiple sclerosis or a tumor. Sometimes a dye is injected into a blood vessel to show blood flow through the arteries and veins.

Your facial pain may be caused by many different conditions, so a correct diagnosis is important. To rule out other conditions, your healthcare team may order other tests.

Choosing the right treatments for trigeminal neuralgia depends on the cause of your pain and many other factors. These include medical history, side effects, risks, how quickly treatments relieve the pain and how long pain relief lasts. There can be overlap in treatment options for the three different types of trigeminal neuralgia. But not all options are right for everyone.

Treatment options may include medicines, surgery, injections or other procedures. If trigeminal neuralgia is caused by another medical condition, such as multiple sclerosis, treatment may be needed for the underlying condition.

Medicines

Often, medicines are recommended as the first line of treatment for trigeminal neuralgia. Sometimes, no other treatment is needed. The following kinds of medicines are common choices to lessen or block the pain signals sent to the brain.

• Antiseizure medicines. Most often, carbamazepine (Tegretol, Carbatrol, others) or oxcarbazepine (Trileptal, Oxtellar XR) are prescribed to treat trigeminal neuralgia. These medicines are shown to be effective in stopping or reducing pain. Genetic testing may be recommended before starting carbamazepine. It is known to trigger a serious reaction in some people, mainly those of Asian descent.

  If these medicines don't work for you, other choices may include gabapentin (Neurontin, Gralise, Horizant) or pregabalin (Lyrica). Lamotrigine (Lamictal), phenytoin (Dilantin, Phenytek, Cerebyx) or topiramate (Qudexy XR, Topamax, others) may be prescribed as well.

  Your care team may increase the dose or switch to another type if these medicines become less effective over time. Side effects of antiseizure medicines may include dizziness, confusion, drowsiness and nausea.

• Muscle relaxants. Muscle-relaxing medicines such as baclofen (Gablofen, Fleqsuvy, others) may be used alone or in combination with carbamazepine. Side effects may include confusion, nausea and drowsiness.
• Botox injections. Small studies have shown that onabotulinumtoxinA (Botox) injections may reduce pain from trigeminal neuralgia in people who are no longer helped by medicines. However, more research needs to be done before this treatment is widely used for this condition.
• Pain relievers. During episodes of pain, lidocaine may be used on its own or with other medicines to offer relief. Results tend to be best when lidocaine is used along with another treatment. Lidocaine is available as an aerosol that can be sprayed into the nose or mouth. Also, it can be injected directly into the area where pain is felt. Or it can be given intravenously (IV). This means it is injected into the bloodstream. Lidocaine treatments often need to be repeated.

Surgery

If medicines don't work, and your pain is caused by a blood vessel pressing on your trigeminal nerve, surgery may be recommended. The surgery for trigeminal neuralgia is called microvascular decompression (MVD). MVD is shown to be most effective for long-term pain relief, although it may come with serious risks.

During MVD, a surgeon moves or removes blood vessels that touch the trigeminal nerve to stop the pain from happening. A cut, known as an incision, is made behind the ear on the side where you feel the pain. Then the surgeon makes a small hole in your skull. This procedure is known as a craniotomy. Through this hole, the surgeon moves any arteries that are in contact with the trigeminal nerve. Finally, a soft cushion is placed between the nerve and the arteries.

If a vein is pressing on the nerve, the surgeon may remove it. Part of the trigeminal nerve may be cut if arteries aren't pressing on the nerve. This is known as a neurectomy.

Microvascular decompression can stop or reduce pain for many years. Long-term pain relief depends on the location of pain, type of pain and age of the person. Only a small number of people may have pain come back 3 to 5 years after surgery.

Risks of MVD include hearing loss, stroke, facial weakness, numbness or other complications. Most people who have this procedure have no facial numbness afterward.

New and alternative treatments for trigeminal neuralgia haven't been as well studied as medicines or surgical procedures. Often, more research is needed to support their use.

However, some people have found improvement with treatments such as low-intensity pulsed ultrasound (LIPUS), acupuncture, biofeedback, chiropractic, laser, and vitamin or nutritional therapy. But these treatments are new or experimental, and results are still being studied. Be sure to check with your care team before you try an alternative therapy because it may interact with your other treatments.

Also, your care team may recommend other self-care methods to help support you through the pain of trigeminal neuralgia. Although these techniques may not treat the nerve directly, they may offer some relief. These methods may include relaxation training, mindfulness and meditation techniques, music, and cognitive therapy.

Living with trigeminal neuralgia can be hard. It can affect your interaction with friends and family, your productivity at work, and the overall quality of your life.

You may find encouragement and understanding in a support group. Group members often know about the latest treatments and tend to share their own experiences. If you're interested, your healthcare team may be able to recommend a group in your area.

Make an appointment with a member of your care team if you have symptoms of trigeminal neuralgia. After your initial visit, you may see a doctor trained in brain and nervous system conditions, known as a neurologist.

What you can do to prepare

• Track your symptoms. Write down any symptoms you've been having, and for how long.
• Note your triggers. Note any triggers that bring on facial pain.
• List your medical history. Make a list of your key medical information. Include any other conditions for which you're being treated. Also include the names of any medicines, vitamins or supplements you're taking and the doses.
• Ask for support. Take a family member or friend along, if possible. Someone who comes with you may remember something that you missed or forgot.
• Write down your questions in advance. It can help you make the most of your time with your healthcare professional.

For possible trigeminal neuralgia, some basic questions to ask include:

• What's the most likely cause of my pain?
• Do I need any diagnostic tests?
• What treatment approach do you recommend?
• If you're recommending medicines, what are the possible side effects?
• Will I need treatment for the rest of my life?
• How much do you expect my symptoms will improve with treatment?
• Is surgery an option?

In addition to the questions that you've prepared, don't hesitate to ask any others that come up during your visit. Also ask questions if you don't understand something.

What to expect from your doctor

You're likely to be asked a number of questions. Being ready to answer them may give you more time to go over points you want to discuss further. Your healthcare professional may ask:

• What are your symptoms and where are they located?
• When did you first develop these symptoms?
• Have your symptoms gotten worse over time?
• How often do you experience periods of facial pain? Have you noticed if anything seems to trigger your facial pain?
• How long does facial pain typically last?
• How much are these symptoms affecting your quality of life?
• Have you ever had dental surgery or surgery on or near your face, such as sinus surgery?
• Have you had any facial trauma, such as an injury or accident that affected your face?
• Have you tried any treatments for your facial pain so far? Has anything helped?
• What side effects have you experienced from treatment?