Trigeminal neuralgia explained

What trigeminal neuralgia is

The trigeminal nerve is the main nerve carrying feeling from your face, and there is one on each side of the head. In trigeminal neuralgia, this nerve fires off pain signals abnormally, producing brief but intense bursts of pain in the cheek, jaw, teeth, gums or around the eye — usually on just one side. Attacks are often described as sudden, sharp, shooting or like an electric shock, lasting from a second or two up to a couple of minutes, and they can come in rapid clusters. Between attacks many people are pain-free, though some develop a more constant aching or burning background pain. It is one of the most severe pains known in medicine, and because it centres on the face and teeth, it is sometimes mistaken at first for a dental problem.

What causes it

In many cases, the pain is caused by a blood vessel pressing on the trigeminal nerve where it leaves the brainstem. The steady pulsing against the nerve is thought to wear away its protective coating, making it misfire and send pain signals. Trigeminal neuralgia can also be linked to conditions that damage this coating more widely, most notably multiple sclerosis, which is why it is more common and can appear younger in people with MS. Less often, a tumour or other structure pressing on the nerve is responsible. In some people no clear cause is found. It becomes more common with age and is slightly more common in women. Because the causes differ, brain scans are often used to look for a blood vessel, MS or another explanation.

Triggers and diagnosis

A striking feature is that ordinary, gentle touch to certain trigger spots can spark an attack. Common triggers include washing the face, shaving, brushing teeth, putting on make-up, eating, drinking, talking, smiling or even a cold wind on the cheek. This can lead people to avoid these activities, affecting eating and self-care. Diagnosis is mainly made from the story of the pain — its shock-like, one-sided, triggered nature — as there is no single blood test for it. Your GP or a neurologist will examine you and usually arrange an MRI scan of the brain to look for a compressing blood vessel, signs of multiple sclerosis, or rarer causes. A dental assessment may be needed too, because facial pain can come from the teeth, and it is important not to have unnecessary dental treatment for nerve pain.

How it is treated

The first treatment is usually medicine rather than painkillers you buy over the counter, which tend not to work for this type of nerve pain. The main medicines calm overactive nerve signals, and the standard first choice in the UK is an anti-epileptic drug used specifically for nerve pain; others may be tried if it is not tolerated. Doses are adjusted carefully by your doctor, and regular reviews check for side effects. If medicines stop working or cause too many problems, referral to a specialist is recommended. Procedures can then be considered, including surgery to move the blood vessel away from the nerve, or treatments that deliberately damage part of the nerve to stop it firing. Each option has benefits and risks, which a neurosurgeon or pain specialist will discuss to find the right choice for you.

Living with trigeminal neuralgia

Trigeminal neuralgia often comes in bouts, with painful spells that can last weeks or months separated by pain-free periods, though the pattern varies. The unpredictability, and the fear of triggering an attack, can affect eating, sleep, work and mood, and low mood or anxiety is common. Practical steps help: taking medicines regularly as prescribed rather than only when in pain, keeping a diary of attacks and triggers, and choosing softer foods and lukewarm drinks during bad spells. Protecting the face from cold wind and being gentle with washing and dental care can reduce flare-ups. It is important to keep up dental hygiene despite the fear of pain, with support from your dentist. Specialist pain services and patient support groups can offer both practical advice and reassurance that you are not alone.