Author: Caitlin Geng
Trigeminal neuralgia is a rare nerve disorder that affects the face. It causes sudden and severe pain in the face, which people describe as a shooting, electric shock-like pain in the teeth, jaw, gums, and other areas of the face.
Trigeminal neuralgia is also known as tic douloureux. Some describe it as “the most excruciating pain known to humankind.” The pain is typically focused on the lower face and jaw, although it sometimes affects other areas of the face, such as around the nose and above the eyes.
Trigeminal neuralgia is caused by irritation of the trigeminal nerve, which starts at the ear and branches out to the forehead, cheeks, and lower jaw. Pain from this disorder is usually limited to one side of the face and can be triggered by actions such as eating or brushing teeth.
This article discusses what trigeminal neuralgia is as well as its symptoms, treatment, diagnosis, and causes. Read on to learn whether the disorder is hereditary and if it can be prevented.
The most typical form of trigeminal neuralgia is type 1, or TN1, which causes attacks of sudden and severe facial pain. The pain can last between seconds and minutes. Attacks can occur one after another in cycles lasting as long as 2 hours.
Type 2, or TN2, is the atypical form of the disorder and is characterized by a constant pain that people have described as aching, stabbing, and burning at a lower intensity than TN1. A person may experience both types of pain, sometimes at the same time, which can be incapacitating.
The trigeminal nerve is one of 12 pairs of nerves attached to the brain. It has three branches that communicate sensations from the top, middle, and lower areas of the face, as well as the oral cavity, to the brain. They are:
- the upper ophthalmic branch, which supplies sensation to:
- most of the scalp
- front of the head
- the middle maxillary branch, which supplies sensation to the:
- upper jaw
- top lip
- sides of the nose
- the lower mandibular branch, which stimulates the:
- lower jaw
- bottom lip
Trigeminal neuralgia can affect more than one nerve branch, but it usually only affects one side of the face. Rarely, the disorder may affect both sides of the face, which is called bilateral trigeminal neuralgia.
Someone with trigeminal neuralgia may have one or more of the following symptoms:
- sudden attacks of severe, shooting pain in the face that last between seconds to around 2 minutes
- pain affecting one side of the face
- excruciating pain in the lower or upper jaw, teeth, or cheek, or — more uncommonly — in the forehead or eye
- a sense that an attack of pain is about to happen, although they typically start suddenly
- a slight ache or burning sensation after the most severe pain has subsided
- regular episodes of facial pain for days, weeks, or months at a time, which may disappear and not return for months or years
Trigeminal neuralgia can sometimes be progressive, with fewer pain-free days as time goes on.
Pain attacks in trigeminal neuralgia can be triggered by:
- brushing teeth
- wind blowing across the face
- touching the face, such as when shaving
Atypical trigeminal neuralgia
Atypical trigeminal neuralgia can be harder to diagnose than TN1. People often describe it as aching or burning rather than stabbing or shocking pain. Pain is usually less severe than with typical trigeminal neuralgia
Similarly to trigeminal neuralgia, temporomandibular joint (TMJ) disorders can also cause facial pain and headaches. However, these conditions are different in nature.
The TMJ is the jaw joint. A number of things can cause this joint to become stiff or painful. Examples include teeth grinding or clenching (bruxism), an uneven bite, or an injury. However, the symptoms of a TMJ disorder are unlikely to be as sudden or severe as trigeminal neuralgia.
TMJ disorders typically cause:
- pain and stiffness in the jaw
- pain around the ear and temples
- popping or clicking sounds when opening the mouth
- a jaw locking sensation
Unlike trigeminal neuralgia, over-the-counter (OTC) pain medications, such as ibuprofen, will often help relieve the symptoms of a TMJ disorder.
Trigeminal neuralgia is treatable with prescription medication and surgery.
OTC pain relieving medications are often not effective for treating trigeminal neuralgia, so doctors may prescribe anticonvulsant medication to reduce or block pain signals sent to the brain by calming nerve impulses.
Carbamazepine (Tegretol, Carbatrol, Epitol) is the only medication approved by the Food and Drug Administration (FDA) for trigeminal neuralgia, but there are other medications doctors prescribe for off-label use. They include:
- valproic acid (Depakene, Depakote)
- gabapentin (Neurontin)
- topiramate (Topamax)
- phenytoin (Dilantin)
- lamotrigine (Lamictal)
Side effects of anticonvulsants may include:
- suicidal thoughts
A doctor may prescribe a muscle-relaxing agent, such as baclofen, either alone or alongside anticonvulsants. Side effects may include confusion, drowsiness, and nausea.
Over time, trigeminal neuralgia can become resistant to pain-blocking medications. Some people also cannot tolerate the available drugs due to their side effects. In these cases, surgery is an option.
There are several types of surgery for trigeminal neuralgia. The type that a person has will depend on their preferences, whether they have any other medical conditions, and other factors. Surgery tends to work better for TN1 rather than TN2.
The options include:
A rhizotomy involves damaging the nerves in order to block pain signals. There are several types of rhizotomy, including:
- Radiofrequency thermal lesioning: This involves doctors using heat to destroy part of the nerve that causes pain. The surgeon passes a hollow needle through the cheek into the nerve and uses a heating current passed through electrodes to destroy nerve fibers.
- Balloon compression: In this surgery, a doctor passes a needle through the cheek to the trigeminal nerve. They then place a balloon in the nerve through a catheter and inflate it where the nerve fibers create pain. The balloon compresses the nerve and injures the fibers that cause pain. The doctor then removes the balloon.
- Glycerol injection: In percutaneous glycerol rhizotomy, the doctor injects glycerol into the area where the nerve branches out into three main parts in order to damage the nerve selectively.
- Stereotactic radiosurgery: In stereotactic radiosurgery, the surgeon uses a gamma knife to deliver a dose of ionizing radiation to the root of the trigeminal nerve. The formation of a lesion on the nerve over time interrupts the transmission of pain from the nerve to the brain.
- Microvascular decompression (MVD): This surgery aims to find a blood vessel that could be compressing the trigeminal nerve. It requires general anesthesia and is the most invasive type of surgery for trigeminal neuralgia. It carries a small risk of facial numbness, stroke, and decreased hearing.
All types of rhizotomy cause some degree of facial numbness. The nerve that doctors damage can also heal over time, allowing pain to return.
A neurectomy involves cutting part of the trigeminal nerve out to prevent pain. Sometimes, doctors perform this if they cannot find a blood vessel that is pressing on the nerve during MVD. This procedure will cause long-lasting numbness in an area of the face.
As with rhizotomy, it is possible for a cut nerve to grow back, and so some people experience recurrence of pain.
Will home remedies help?
The main home remedy people can use for trigeminal neuralgia is avoiding pain triggers. If a person can identify actions or events that cause an attack, they can adapt to avoid them in future. Some examples include:
- wearing a scarf over the face to protect against wind
- preventing drafts of cold air in the home
- sitting away from air conditioning units or fans
- avoiding spicy, hot, or cold foods
- using a straw to drink cold drinks
- eating mushy or liquid foods that do not require much chewing
There is no evidence that home remedies can cure trigeminal neuralgia, but some people find complementary therapies helpful for managing the pain and the impact it has on their lives. People may want to consider:
- mental health support
Trigeminal neuralgia is often diagnosed by a dentist, as people often report pain in their teeth and jaw. A dentist may ask questions about the symptoms and perform a dental X-ray to rule out other, more common causes of facial pain, such as:
- TMJ disorder
- cluster headaches
- postherpetic neuralgia, which occurs after someone has shingles
A medical professional will usually diagnose the disorder based on a description of the pain and symptoms once they have ruled out other possibilities. Next, a doctor will typically order an MRI scan to see if there is an underlying cause for the condition.
Trigeminal neuralgia can be primary or secondary. If it is secondary, it means there is another condition that is causing the pain. This could be:
- a cyst
- facial injury
- previous surgery
- multiple sclerosis (MS), or another condition that damages the protective sheath around nerves
- in rare cases, a tumor
An MRI scan may be able to detect signs of some of these underlying causes.
Primary trigeminal neuralgia is not caused by another condition. Often, it happens because a blood vessel is pressing on a nerve. An MRI can sometimes pick up on this, but not always. In most cases, the cause of trigeminal neuralgia is unknown.
Sometimes, trigeminal neuralgia can be due to an injury to the trigeminal nerve.
It is unclear if trigeminal neuralgia is related to genetics. A 2021 review states that around 1–2% people with trigeminal neuralgia have a relative with the condition. However, because so few people have the condition, it is difficult to know how influential genetics might be.
Most people with this condition do not have family members with trigeminal neuralgia.
There are currently no guidelines on preventing the development of trigeminal neuralgia. However, people who already have the condition may be able to prevent attacks and pain by keeping track of potential triggers and avoiding them.
Trigeminal neuralgia is a nerve disorder that affects the face. It causes sudden and severe pain in areas of the face, usually only on one side.
Treatment usually consists of medication such as anticonvulsants or surgery such as rhizotomy or neurectomy. Identifying and avoiding triggers may help with reducing attacks.
Living with a chronic pain condition may be difficult for some individuals. People with trigeminal neuralgia may need support for their physical and mental health.