Trigeminal Neuralgia (TN)

Trigeminal neuralgia is a facial nerve pain condition involving the trigeminal nerve. Symptoms vary by type, but most people experience sudden, severe pain on one side of the face, often in the jaw or cheek. The pain may feel burning or sharp and can be intense enough to make eating or drinking difficult.

A flare-up may begin with tingling or numbness in the area. Pain then starts to come and go in bursts lasting from a few seconds up to 2 minutes. During a flare, these bursts can become more frequent, sometimes feeling nearly continuous. The intensity can be very disruptive, but the condition is not life-threatening.

Trigeminal neuralgia is chronic and tends to cycle. Flares can last for weeks or months, followed by symptom-free periods that may last months—or even years.

Trigeminal neuralgia type 1 (TN1):

• The pain comes in sudden bursts.
• It feels like being shocked with electricity or stabbed with a knife in the face.
• The attacks can be so quick that they last just a few seconds, but they are extremely intense.
• Even light touches, like brushing your teeth, chewing, or a breeze on your cheek, can set it off.
• People often say it’s some of the worst pain a person can feel, even though it doesn’t last long.

Trigeminal neuralgia type 2 (TN2):

• The predominant component of pain is more of a constant ache or burning feeling in the face. Patient often also feel a component of pain similar to being shocked by electricity, but this component is less than 50% of the total pain.
• Pain can sometimes last for hours at a time.
• People describe the predominant component as a dull, throbbing, or aching pain, like having a bad toothache or a hot, burning pressure in the face.

This pain condition happens most often in people older than 50. But younger people can also have it. Trigeminal neuralgia is more common in women than men. 

The pain can be triggered by pressure on your cheek. This pressure can come from a razor when shaving. Or from your fingers when putting on makeup. Brushing your teeth, standing in the wind, washing your face, eating, drinking, and even talking also may cause it.

Experts think that a blood vessel pressing against the trigeminal nerve triggers the pain. Sometimes multiple sclerosis (MS) causes the pain. In rare cases, a tumor may be the cause. An MRI should be done to make sure it is not a tumor or MS.

People with trigeminal neuralgia may have these symptoms:

• Flashes of severe pain in the cheek or jaw, rarely on both sides.
• Absence pain between the flashes of pain.
• The pain feels like electric shocks or like a knife.
• Pain is often triggered by touching, wind, eating, or brushing the teeth.
• Anxiety from the thought of the pain returning.

To diagnose trigeminal neuralgia, your healthcare provider will typically take your health history and do a physical exam. Giving your provider details about the pain may help with making a diagnosis. This includes things such as where and when the pain happens. Imaging tests may be used to try to rule out other causes of pain.

Most common over-the-counter and prescription pain medicines don’t work for people with this condition. Treatment for trigeminal neuralgia may include:

• Anticonvulsant medicine.

• Tricyclic antidepressants.

• Surgery, if medicine has failed.

• Acupuncture.

• Biofeedback.

• Stereotactic radiosurgery.

• Percutaneous balloon rhizotomy.

• Radiofrequency ablation.

Experts don’t know how to prevent trigeminal neuralgia. You may learn to avoid certain activities that seem to trigger the pain more than others.

This condition is not fatal. But the pain and anticipation of the pain can interfere with your life. Working closely with your healthcare provider will help you find the best pain management methods for you. Alternative therapies have also been shown to help. These include acupuncture and biofeedback.

If you are living with facial pain, the Headache & Facial Pain Center at the University of Cincinnati Gardner Neuroscience Institute is here to support you.  We offer individualized treatment from a team committed to your relief. Call us at 513-475-8730.