Trigeminal neuralgia

Symptoms of trigeminal neuralgia

The main symptom of trigeminal neuralgia is sudden attacks of severe sharp shooting pain affecting your face.

It can last from a few seconds to about two minutes.

The pain is often described as excruciating, similar to an electric shock.

Trigeminal neuralgia usually affects one side of the face. In rare cases it can affect both sides, although not at the same time.

The pain can be in the teeth, lower jaw, upper jaw, cheek and, less commonly, in the forehead or the eye.

After the main severe pain has stopped, you may experience a slight ache or burning feeling.

You may also have a constant throbbing, aching or burning sensation between attacks.

You may experience regular episodes of pain for days, weeks or months at a time. Sometimes the pain may disappear completely and not return for several months or years. This period is known as remission.

In severe cases of trigeminal neuralgia attacks may occur hundreds of times a day and there may be no periods of remission.

Symptom triggers

Attacks of trigeminal neuralgia can be triggered by certain actions or movements, such as:

• talking
• smiling
• chewing
• brushing your teeth
• washing your face
• a light touch
• shaving or putting on make-up
• swallowing
• kissing
• a cool breeze or air conditioning
• head movements
• vibrations, such as walking or a car journey

Pain can occur spontaneously with no trigger.

Living with trigeminal neuralgia can be very difficult. It can have a significant impact on a person's quality of life, resulting in problems such as weight loss, isolation and depression.

When to seek medical advice

See your GP if you experience frequent or persistent facial pain. This is particularly  important if standard painkillers, such as paracetamol and ibuprofen, don't help and a dentist has ruled out any dental causes.

Your GP will try to identify the problem. They will ask about your symptoms and rule out conditions that could be responsible for your pain.

Diagnosing trigeminal neuralgia can be difficult and it can take a few years for a diagnosis to be confirmed.

Causes of trigeminal neuralgia

Trigeminal neuralgia is usually caused by compression of the trigeminal nerve. This is the nerve inside the skull that sends sensations of pain and touch from your face, teeth and mouth to your brain.

The compression of the trigeminal nerve is usually caused by a nearby blood vessel pressing on part of the nerve inside the skull.

In rare cases trigeminal neuralgia can be caused by damage to the trigeminal nerve as a result of an underlying condition, such as multiple sclerosis (MS) or a tumour.

Typically the attacks of pain are brought on by activities that involve lightly touching the face, such as washing, eating and brushing the teeth.

They can also be triggered by wind – even a slight breeze or air conditioning – or movement of the face or head. Sometimes the pain can occur without any trigger at all.

Who's affected

It's not clear how many people are affected by trigeminal neuralgia, but it's thought to be rare.

Women tend to be affected by trigeminal neuralgia more than men. It usually starts between the ages of 50 and 60. It's rare in adults younger than 40.

Treating trigeminal neuralgia

Trigeminal neuralgia is usually a long-term condition. The periods of remission often get shorter over time. Most cases can be controlled with treatment to at least some degree. Your GP or neurologist will discuss treatment options with you.

There are a number of minor surgical procedures that can be used to treat trigeminal neuralgia, but these are generally only effective for a few years.

Postherpetic neuralgia

Postherpetic neuralgia is a more common type of nerve pain that usually develops in an area previously affected by shingles.

More useful links

• How to use your health services
• Trigeminal neuralgia