Trigeminal Neuralgia

Trigeminal neuralgia is a type of chronic facial pain caused by a problem with the trigeminal nerve, one of the main nerves carrying sensation from the face to the brain. It produces sudden attacks of severe, sharp, or shock-like pain, usually on one side of the face.

The pain often affects the cheek, jaw, teeth, or gums, and sometimes the forehead or eye area. Attacks can last from a few seconds to a couple of minutes and may happen many times a day. Periods of frequent attacks can be followed by spells with little or no pain.

The hallmark symptom is sudden, severe facial pain that feels like a sharp stabbing sensation or an electric shock. It usually affects one side of the face and can be triggered by light touch or everyday actions such as eating, talking, brushing the teeth, shaving, washing the face, or even a gust of wind.

Some people also have a more constant aching or burning between the sharp attacks. The pain can be so intense that people avoid activities that might trigger it. Because it can involve the teeth and jaw, it is sometimes mistaken for a dental problem at first.

Trigeminal neuralgia is often caused by a blood vessel pressing on the trigeminal nerve near the brain, which can wear away the nerve's protective covering and cause it to misfire. It becomes more common with age.

Less commonly, it can be linked to other conditions that affect the nerve, such as multiple sclerosis or, rarely, a tumour pressing on the nerve. Because of this, doctors may arrange scans to look for an underlying cause, particularly in younger people or when symptoms are unusual.

There is no single test for trigeminal neuralgia. Diagnosis is based mainly on the description of the pain, including how it feels, where it occurs, how long attacks last, and what triggers them. A typical pattern of sudden, one-sided, shock-like facial pain triggered by light touch strongly suggests the condition.

An MRI scan is often arranged to look for a blood vessel pressing on the nerve and to rule out other causes such as multiple sclerosis or a tumour. Because the pain can mimic dental or sinus problems, other conditions usually need to be excluded first.

Standard painkillers such as paracetamol usually do not help. The first-line treatment is medicines that calm overactive nerve signals, including certain anti-seizure medicines. These are started at a low dose and adjusted, and they can reduce the frequency and severity of attacks. Regular review is needed to balance benefit and side effects.

If medicines stop working, cause troublesome side effects, or are not tolerated, procedures may be considered. These include surgery to move the blood vessel away from the nerve, and treatments that deliberately damage part of the nerve to interrupt pain signals, including targeted radiation or injection or heat-based techniques. A specialist can explain the benefits and risks of each option.

Trigeminal neuralgia cannot be prevented, but identifying and avoiding personal triggers can help reduce attacks. Keeping warm in cold weather, eating soft foods during a flare, and protecting the face from wind may make daily life easier for some people.

The condition often follows a pattern of bouts and remissions, and the course varies from person to person. Many people gain good control with medication, at least for a time, and procedures can help when needed. Because the pain can affect mood, eating, and quality of life, support for emotional wellbeing is also important. Seek prompt review if the pain changes in character or other new symptoms develop.