Trigeminal neuralgia (TN) is a condition that can cause intense facial pain sometimes so severe it can interfere with the normal activities of daily living. Brief, painful episodes may be triggered by chewing, talking, smiling, brushing teeth, shaving, or light pressure on the face. The pain may be sudden, intense, and sporadic (off and on). It also may be more constant but less severe.
Usually, TN affects only one side of the face. In this case, it is said to be unilateral. If both sides of the face are affected, the condition is bilateral. The right side of the face tends to be affected slightly more often than the left side.
The trigeminal nerve is responsible for transmitting sensations of touch and pain from the face and head to the brain. The trigeminal nerve has three branches. One branch carries nerve impulses from the forehead, upper eyelids, and eyes to the brain. The second branch is responsible for sensation in the lower eyelids, cheeks, nostrils, upper lip, and upper gum. The third branch serves the lower lip, lower gum, jaws, and some muscles used for chewing.
There are two main forms of TN:
TN may be progressive, meaning that the condition worsens over time. At first, pain may be limited to the upper or lower jaw, and patients might think it is due to dental problems. The intervals between attacks may become shorter or disappear altogether, while efforts to manage pain with medication may be less effective.
Pain that accompanies TN may be so intense that it becomes debilitating. People with TN may avoid normal activities due to concerns that a painful episode will occur.
About 150,000 new cases of trigeminal neuralgia are diagnosed each year. It is more likely to occur in people over age 50, although people of any age may be affected. Typical trigeminal neuralgia is rare in people less than 40 years old. Multiple sclerosis should be considered in younger patients with TN. The incidence of trigeminal neuralgia in patients with MS is 1% to 2%.
There are several conditions that may result in TN, but usually it is caused by pressure on the nerve exerted by a blood vessel near the brain stem. Multiple sclerosis (MS) causes the deterioration of the nerve coating called the myelin sheath, so people with MS may also develop TN.
Less commonly, a tumor or vascular lesion may cause nerve compression. Injury to the trigeminal nerve due to oral or sinus surgery, stroke, or facial trauma are other causes of facial nerve pain that may be similar to TN type pain.
Your doctor will ask questions about your symptoms and medical history. He or she will perform a physical examination of the head and neck areas, including the ears, mouth, teeth, and temporomandibular joint (TMJ).
Other disorders may cause facial pain and mimic TN type pain so they need to be ruled out before a definite diagnosis is made. These include cluster headaches or migraines, post-herpetic neuralgia (pain following an outbreak of shingles), or TMJ disorder. Sinusitis and ear infections must also be ruled out.
A magnetic resonance imaging (MRI) scan may be performed to rule out the presence of a brain tumor, multiple sclerosis, or other causes. The scan might indicate whether a blood vessel is pressing on the nerve.
Several options can be used to treat TN. These include medications, surgery, and complementary therapies.
Patients who do not respond to drug therapy or whose condition worsens over time may be candidates for surgery. Several procedures are used to treat TN, depending on the severity of the pain, the patient’s preference, physical health, previous surgeries, and surgeries’ relative risks and benefits.
Percutaneous (through the skin) surgical techniques include
Open (invasive) surgical procedures include
Stereotactic radiosurgery includes
Other approaches that may be used in conjunction with drug therapy include:
Additional therapies that may be helpful include:
© Copyright 1995-2019 The Cleveland Clinic Foundation. All rights reserved.
This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 03/25/2016