Trigeminal Neuralgia
PAIN CONDITION
Trigeminal Neuralgia Pain: Causes, Treatment & Pain Relief
Trigeminal neuralgia (TN), also called tic douloureux or Fothergill’s disease, is a debilitating facial pain condition.[1] It causes sudden, severe pain attacks on one side of your face, usually in your cheek, mouth, forehead, and eye area.[1] Simple actions like talking, eating or touching your face can trigger intense, electrical shock-like pain. These excruciatingly painful attacks happen when your trigeminal nerve is damaged, irritated, compressed, or affected by other medical conditions that impact the nerve.
TN is a chronic, neuropathic condition with no known cure but there are treatments available to manage your symptoms and help improve the quality of your life.
About Trigeminal Neuralgia
Trigeminal neuralgia affects the trigeminal nerve, which is responsible for sensation in your face. The nerve starts near the top of your ear before branching out to your forehead, cheeks, and jaw. [2] TN often occurs when blood vessels press on the trigeminal nerve and eventually wear away its protective covering (myelin sheath).[3] When irritated, damaged or compressed, the nerve misfires, sending pain signals to the brain even when there’s no real cause. [4] The pain can be so extreme that many describe it as stabbing, piercing, or like an electrical shock. [2]
While TN can affect anyone at any age, it is more common in people over 50 and occurs more frequently in women than men. [2] Pain episodes may start mild and infrequent, but they often become incredibly intense and happen more often over time. [2]
Trigeminal Neuralgia Symptoms
Trigeminal neuralgia occurs more often in women than men, is more common in people over 50, affects the right side more than the left and is known to run in families.[2]
According to the Mayo Clinic, trigeminal neuralgia symptoms may include:
- Intense, shooting, or jabbing pain that feels like an electric shock.
- Sudden pain triggered by touch, chewing, speaking, or brushing teeth.
- Pain lasting seconds to minutes, sometimes accompanied by facial spasms.
- Episodes that last days, weeks, or months, with pain-free periods in between.
- Pain in the cheek, jaw, teeth, gums, or lips—sometimes affecting the eye and forehead.
- Pain occurring on one side of the face at a time.
- Pain that may stay in one spot or spread over a wider area.
- Rarely happens during sleep.
- Episodes become more frequent and intense over time.
Trigeminal Nerve Pain Causes
TN is typically caused by a blood vessel pressing against the trigeminal nerve near the brainstem, gradually wearing down its protective covering and leading to erratic pain signals. Other possible causes of severe facial pain due to tic douloureux include:
- Primary (classic) TN: The most common cause is a blood vessel pressing on the trigeminal root.[1]
- Secondary TN: Due to a condition damaging or affecting the trigeminal nerve, like pressure from a tumor, multiple sclerosis (MS), or arteriovenous malformation.[1]
- Idiopathic TN: The catch-all diagnosis for facial pain with no apparent cause even after diagnostics efforts.[1]
- Stroke [4]
- Facial trauma [4]
- Surgical injury [4]
Pain Management Treatments for Trigeminal Neuralgia
While TN may be considered one of the most excruciating pains, there are treatments available to make living with this condition possible. The first line of treatment usually consists of anticonvulsant medications despite side effects, and higher doses are necessary for relief.[3] Muscle relaxers also help ease painful attacks.
Lifestyle changes such as low-impact exercise, healthy eating and meditation can promote physical and mental wellness. Alternative therapies like yoga, massage, chiropractic care, acupuncture and biofeedback therapy also benefit trigeminal nerve pain patients.
A multimodal treatment plan may include medications, wellness activities, complementary therapy and intervention pain management procedures. Nerve blocks and Botox injections may help reduce pain when medication no longer helps.[5] Radiofrequency ablation is a minimally invasive procedure that disrupts nerve signals to relieve TN symptoms.
Combining pain management with medication, healthy lifestyle modifications, and alternative therapies can relieve pain episodes, minimize trigger responses, and improve your everyday life.
Interventional pain control procedures for TN pain include:
- Neuromodulation or peripheral nerve stimulation (PNS)
- Ultrasound or fluoroscopy-guided injections
- Combined glycerol and radiofrequency ablation
- Cryoablation
- Transcutaneous Electrical Nerve Stimulation (TENS)
- Transcranial magnetic stimulation
- Trigeminal nerve blocks
- Peripheral nerve blocks
- Dorsal root ganglion (DRG) stimulation
- Spinal cord stimulation (SCS)
- Intrathecal pain pump
- Complementary therapies like massage, chiropractic care, acupuncture, yoga, tai chi, meditation, and physical therapy may also provide relief. When returning to activities or sports, ease in slowly, focusing on proper warm-ups and conditioning to avoid further strain.
When to Consult a Trigeminal Neuralgia Pain Care Specialist
Not everyone experiences trigeminal neuralgia the same way. If you’re having persistent pain episodes or noticing that your TN pain is worsening, your current medications may be becoming less effective. You don’t have to live in constant pain. Pain management clinics offer comprehensive treatment approaches to ease your pain while improving your mental health and daily life.
Your trigeminal neuralgia diagnosis may always be present, but your painful attacks don’t have to be. Talk with your pain specialist about treatment options that can help control your debilitating pain and allow you to regain the power to live life fully.
Disclaimer: This webpage was written to provide helpful information about trigeminal neuralgia and is not meant to diagnose, treat or replace your medical care. Seek immediate care for sudden, severe facial pain that is different from your usual TN symptoms, persistent numbness or weakness in the face, difficulty speaking, vision changes, or loss of consciousness. While trigeminal neuralgia can be extremely painful, other severe conditions—such as stroke, multiple sclerosis, brain tumors, or aneurysms—can sometimes mimic TN symptoms. Always consult a doctor for proper diagnosis and treatment.
Resources:
- Trigeminal Neuralgia. Cleveland Clinic [Internet]. Accessed February 28, 2025. Available from: https://my.clevelandclinic.org/health/diseases/15671-trigeminal-neuralgia-tn
- Trigeminal Neuralgia. Johns Hopkins Medicine [Internet]. Accessed February 28, 2025. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/trigeminal-neuralgia
- Pilitsis JG, Khazen O. Trigeminal Neuralgia. American Association of Neurological Surgeons – AANS [Internet]. April 10, 2024. Accessed February 28, 2025. Available from: https://www.aans.org/patients/conditions-treatments/trigeminal-neuralgia/
- Mayo Clinic Staff. Trigeminal Neuralgia – Symptoms and Causes. Mayo Clinic [Internet]. Published January 26, 2022. Accessed February 28, 2025. Available from: https://www.mayoclinic.org/diseases-conditions/trigeminal-neuralgia/symptoms-causes/syc-20353344
- Mayo Clinic Staff. Trigeminal neuralgia – Diagnosis and treatment. Mayo Clinic [Internet]. Published 2017. Accessed February 28, 2025. Available from: https://www.mayoclinic.org/diseases-conditions/trigeminal-neuralgia/diagnosis-treatment/drc-20353347