Trigeminal Neuralgia

Written by Marijke Vroomen Durning, RN
Medically Reviewed by Poonam Sachdev on September 24, 2024
7 min read

Trigeminal neuralgia is an ongoing pain condition that affects certain nerves in your face. You might also hear it called “tic douloureux.” It causes sudden and severe pain that some people with the condition describe as feeling like an electric shock. Doctors have treatments that may help, including medicine and surgery.

To learn about trigeminal neuralgia, it helps to know a little about how the affected nerves are laid out.

In your head, you have 12 pairs of cranial nerves. The trigeminal nerves are among these pairs, and they let you feel sensations in your face. One nerve runs down each side of your head.

Each trigeminal nerve splits into three branches, controlling the feeling for different parts of your face. They are:

  • The ophthalmic branch controls your eye, upper eyelid, and forehead.
  • The maxillary branch affects your lower eyelid, cheek, nostril, upper lip, and upper gum.
  • The mandibular branch runs along your jaw, lower lip, lower gum, and some muscles you use for chewing.

The disorder can affect any of the three nerve branches, meaning you could feel pain anywhere from your forehead to your jaw. Usually, you’ll feel pain on only one side of your face. Some people feel it on both sides. When that happens, it’s called bilateral trigeminal neuralgia.

You may feel as though your pain came out of nowhere. Some people with this condition start out thinking they have an abscessed tooth and go to a dentist.

For people who have what’s called “atypical” trigeminal neuralgia, known as type 2, the pain is usually less intense but constant. Doctors consider sudden and intense bouts of pain to be signs of “classic” trigeminal neuralgia. If your pain is more of an aching, burning sensation, you might have the atypical form.

Common symptoms of trigeminal neuralgia may include:

  • Brief periods of stabbing or shooting pain
  • Pain triggered by things such as brushing your teeth, washing your face, shaving, or putting on makeup; even a light breeze against your face might set off your pain
  • A burning or achy sensation that may come before intense pain
  • Episodes lasting a few seconds to several minutes
  • Attacks that happen several times a day or a week, followed by pain-free periods known as remission
  • Pain that usually affects only one side of the face
  • Pain that may affect just one part of your face or spread to a wider area
  • Episodes that happen more often over time, with worsening pain
  • Pain mostly in your cheek, jaw, teeth, gums, and lips; the eyes and forehead are affected less often
  • Uncontrollable facial twitch after an attack

Some people with this condition also have anxiety because they are uncertain when the pain will return.

Trigeminal neuralgia eye symptoms

Trigeminal neuralgia rarely affects the ophthalmic branch of nerves. If you have it, you might have some of these symptoms:

  • Shock-like pain around the eye
  • Pain around the nose
  • Pain around the scalp
  • Red eyes
  • Dry eyes
  • Unexplained tears in both eyes when you have pain, even if the pain is only in one

Several things may cause trigeminal neuralgia pain, such as:

  • Touching your face
  • Shaving
  • Washing your face
  • Brushing your teeth
  • Applying makeup
  • Blowing your nose
  • Eating or drinking, especially hot or cold foods or drinks
  • Talking
  • Smiling
  • Having wind or a breeze blow at you

Bananas and trigeminal neuralgia

Some people say that you should avoid eating bananas and other foods that are high in potassium if you have trigeminal neuralgia. Although there’s no research to support this, some people have found that bananas can trigger their pain. That said, researchers believe that potassium may help ease pain in some people, so this is likely different for everyone.

Although no particular foods are known to trigger trigeminal neuralgia pain, many people with the condition avoid foods that are hot or spicy, caffeine, citrus, and cold drinks.

It starts with irritation of the trigeminal nerve. You might have a blood vessel pressing on the nerve, damaging the protective coating around it, which is called the myelin sheath.

Certain diseases, such as multiple sclerosis, also can injure the myelin sheath. Sometimes, a tumor or a tangle of arteries presses on the nerve.

Your trigeminal nerve can also be injured — perhaps by surgery, an accident, or a stroke.

Some people are more likely to get trigeminal neuralgia than others:

  • Women are more likely than men to get trigeminal neuralgia.
  • The condition is more common in people older than 50.
  • It may run in families, perhaps because of how blood vessels are formed in the brain.
  • It may also be linked to high blood pressure.

Although the pain is intense, the condition is not life-threatening. It can be a progressive disease, meaning that it gets worse over time.

If you have facial pain — especially sensations that keep coming back or don’t respond to over-the-counter pain relievers — make an appointment with your doctor. Be ready to tell your doctor about how your pain first appeared, how often you feel it, and what seems to trigger it. Expect your doctor to ask lots of questions about your symptoms. You may also have a neurological exam, in which your doctor touches various parts of your face. They can test your reflexes to figure out whether a nerve is compressed. An imaging test such as an MRI can show if a tumor or multiple sclerosis is an underlying cause of your problem.

Trigeminal neuralgia is often misdiagnosed, and it can take time to get the correct diagnosis. Several conditions cause facial pain, and their symptoms can overlap with trigeminal neuralgia:

Treatment for this condition may include medication and surgery.

Medication. Typical pain medications don’t work well for people with trigeminal neuralgia, but your doctor may prescribe different types of drugs:

  • To keep the nerves from reacting to irritation, you may take anticonvulsant medications.
  • You also may take muscle relaxants, either alone or along with anticonvulsants.
  • Your doctor may suggest a tricyclic antidepressant to manage your symptoms.
  • Some research suggests that Botox shots may be helpful when other medication doesn’t relieve trigeminal neuralgia pain. More research is needed before doctors can prescribe this widely.

Surgery. Over time, your medication may help you less and less. If that happens, you have several surgical options.

Some of these procedures are outpatient, meaning you don’t have to be admitted to a hospital. For some, you’ll need general anesthesia, which means you won’t be awake during the surgery.

Your doctor can help you decide which surgery is right for you, based on your overall health, which nerves are involved, and your preferences.

Procedures to treat trigeminal neuralgia include:

Gamma knife radiosurgery. It uses radiation focused on your trigeminal nerve.

Balloon compression. Doctors thread an empty balloon into a space between the trigeminal nerve and the base of the skull. When the balloon is inflated, the nerve is pressed against hard bone, damaging its insulation so you don’t feel pain from light touches.

Glycerol shots. These are injected into the spinal fluid surrounding the trigeminal nerve at the base of the skull. This injures the insulation around the nerve, which eases pain.

Radiofrequency ablation. Doctors and patients identify the exact area within the trigeminal nerve that causes excessive pain. Then, the doctor can send an electrical current to the spot to dull the sensation.

Microvascular decompression. This involves moving or removing blood vessels that are affecting the nerve.

Neurectomy. In this, the trigeminal nerve is partly cut to relieve pain.

You can explore alternative ways to help manage the symptoms of trigeminal neuralgia. These are some you may want to ask your doctor about:

  • Acupuncture -- a traditional Chinese medicine that uses very thin needles to balance the flow of energy in your body
  • Aromatherapy -- the use of plant oils, such as peppermint, lavender, and others, to help healing
  • Meditation
  • Yoga
  • Biofeedback -- learning how to control your body to reduce pain
  • Chiropractic care

Some people with trigeminal neuralgia get some relief with exercise. General low-impact exercises, such as walking or swimming, may help your body by releasing endorphins and lowering your stress levels. This can help ease pain. There are also a few exercises specific to your neck and face that might be helpful.

Progressive muscle relaxation. Relax your facial and neck muscles slowly one by one.

Gentle stretches. Keep your shoulders relaxed while doing these:

  • Slowly tilt your head from one side to another
  • Slowly bring your head forward, as if nodding yes
  • Slowly turn your head from side to side

Facial muscle exercises

  • Open your mouth wide and hold for a few seconds, then close it, relaxing your jaw.

Yoga can also provide several benefits by helping you relax and gently stretching the neck muscles. Several poses, such as Child’s Pose (balasana) and Cat-Cow Pose (Marjaryasana-Bitilasana), can help release neck tension. However, unless you are experienced in yoga, it’s best to speak with a yoga instructor first before trying any poses to avoid causing harm.

Trigeminal neuralgia is an extremely painful condition that affects the nerves in your face. The pain can be constant or come and go. It can be hard to get a trigeminal neuralgia diagnosis right away. That's because several other disorders, such as sinusitis, certain types of headaches, and even problems with your teeth, can cause similar pain. However, there are treatments that may help ease the pain, so it’s important to work with your doctor to see what will work for you.

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