Trigeminal neuralgia 

Introduction 

Trigeminal neuralgia is sudden, severe facial nerve pain 

Postherpetic neuralgia

This article focuses on trigeminal neuralgia, a rare type of neuralgia most commonly seen in people between the ages of 50 and 60.

Postherpetic neuralgia is a more common type of neuralgia that usually develops after a previous shingles infection.

Read more about postherpetic neuralgia.

Trigeminal neuralgia is a sudden, severe facial pain, described as sharp, shooting or like an electric shock.

It usually occurs in sudden short attacks lasting from a few seconds to about two minutes, which stop just as abruptly.

In the vast majority of cases it affects part or all of one side of the face, with the pain most commonly felt in the lower part of the face. Very occasionally it affects both sides of the face, but not normally at the same time.

People with the condition may experience attacks of pain regularly for days, weeks or months at a time. In severe cases, attacks may occur hundreds of times a day.

It's possible for the pain to improve or even disappear altogether for several months or years at a time (known as a period of remission), although these periods of remission tend to get shorter with time. Some people may then go on to develop a more continuous aching, throbbing and burning sensation, sometimes accompanied by the sharp attacks.

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

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

Read more about the symptoms of trigeminal neuralgia.

When to seek medical advice

You should see your GP if you experience frequent or persistent facial pain, particularly if standard painkillers such as paracetamol and ibuprofen do not help and a dentist has ruled out any dental causes.

Your GP will try to identify the problem by asking about your symptoms and ruling out conditions that could be responsible for your pain.

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

Read more about diagnosing trigeminal neuralgia.

What causes trigeminal neuralgia?

In the vast majority of cases, trigeminal neuralgia is caused by compression of the trigeminal nerve. This is the largest nerve inside the skull, which transmits sensations of pain and touch from your face, teeth and mouth to your brain.

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

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

Read more about the causes of trigeminal neuralgia.

Who is affected

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

Some studies have suggested that around 27 in every 100,000 people are diagnosed with the condition in the UK each year, although this figure is probably too high as the condition tends to be over-diagnosed by doctors. Other estimates have suggested that there are about 6,500 new cases diagnosed each year in the UK.

The condition affects women more often than men and is rare in people under the age of 40, although it can occur in younger people. Most cases are first seen in people between the ages of 50 and 60.

How trigeminal neuralgia is treated

Trigeminal neuralgia is usually a long-term condition, and the periods of remission often get shorter over time. There is currently no definitive cure, but most cases can be controlled to at least some degree with treatment.

The first treatment offered will usually be with an anticonvulsant medication (usually used to treat epilepsy) called carbamazepine. To be effective, this medication needs to be taken several times a day, with the dose gradually increased over the course of a few days or weeks so that high enough levels of the medication can build up in your bloodstream.

Unless your pain starts to diminish or disappears altogether, the medication is usually continued for as long as is necessary, sometimes for many years. If you are entering a period of remission and your pain goes away, stopping the medication should always be done slowly over days or weeks, unless you are advised otherwise by a doctor.

Carbamazepine was not originally designed to treat pain, but it can help relieve nerve pain by slowing down electrical impulses in the nerves and reducing their ability to transmit pain messages.

If this medication is ineffective, unsuitable or causes too many side effects, you may be referred to a specialist to discuss alternative medications or surgical procedures that may help.

There are a number of minor surgical procedures that can be used to treat trigeminal neuralgia – usually by damaging the nerve to stop it sending pain signals  but these are generally only effective for a few years.

Alternatively, your specialist may recommend having surgery to open up your skull and move away any blood vessels compressing the trigeminal nerve. Research suggests this operation offers the best results in terms of long-term pain relief, but it is a major operation and carries a risk of potentially serious complications, such as hearing loss, facial numbness or, very rarely, a stroke.

Read more about treating trigeminal neuralgia.

Page last reviewed: 22/07/2014

Next review due: 22/07/2016

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Comments

The 13 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Ten sufferer said on 19 April 2014

I have been suffering with this awful condition for the past 16 years or so, I have been prescribed many different medications such as gabapentin, carbamazepine, amitryptiline, to name but a few!!! I typically have the tn2 pain which is a relentless pulling, burning, constant dull ache 24/7!
I feel it is a lot worse when tired which at times is completely unbarable, I've tried hot and cold compresses, and even the creams with the chilli extracts to rub on the affected area!!
The only medication which gives a temporary relief for me is solpadol or dihydrocodeine, but these only tend to give part relief for a couple of hours or so, but when you have the constant ache, you will do anything for a bit of respite from the pain!!
I can sympathise with those of you you suffering with this, lets hope there's a breakthrough treatment for it soon!!

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wendyrmn said on 02 March 2014

I've suffered this for 20years but its becoming more frequent now. Had acipuncture 18 months ago and worked initially with remarkable results but then had scale and polish which was a bit aggressive. TN came back but pain shifted elsewhere but no longer in scalp! Now symptoms of TMJ. Totally fed up. Never taken carbemazepine or other neuro treatments from gp. Can't afford side effects.
Researched it 4 years ago and found strong vitamin b to help (repairs nerve damage). You must check this out first though as cannot be taken with certain meds.
Try hot water bottle. If you find this irritates the pain then try cold damp face cloth out of fridge! :) when the cold starts to hurt then switch to warm compress.
When your this desperate you try anything for relief! Just sent enquiry on Prolotherapy!? Check it out...innovation from New Zealand doc..sounds promising but expect to pay private.
Good luck to all TN sufferers and hang on in there :)

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HannahLee said on 28 February 2014

I'm sure all TN sufferers will sympathise, but hopefully someone has advice for me: I have a cavity needing a filling top jaw on the side of my TN, exactly where the worst of my irritation occurs. What now?? Carbamazapine is currently enough for me to manage my TN2 but I'm worried that any prodding in my mouth might irritate the nerve permanently and make it harder to manage. What is worse, the injection or going 'cold turkey', extraction or filling? I can't find a single dentist able to give me advice. Please help!

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Prometheus2869 said on 01 February 2014

On Friday (31 Jan 14) I was told I may have TN. I have never felt pain like it. It has been getting gradually worse as the week has progressed to the point that I have an almost constant dull pain down the right side of my face and the major episodes have been excruciating and on occasion have lasted for 10 mins or more. I am currently on 'carbamazepine' (100mg) and 'tramadol' (50mg). Can't say that they are doing much at present. I have only had about 3 hours sleep in the last 4 days. My head feels like it will explode.

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Suzy53 said on 14 December 2013

Started with nuralgia in June 2013 had different pills seems to be getting worse awaiting for an MRI scan never experienced anything like this. Drugs just dull the pain , currently taking carbamazepine was on gabapentin 1200mg but made me docile why does me neck hurt at the back ?
Feel as I have a fat lip tingling face burning did have dental surgery and bingo this came about three weeks later was it the dentist that caused it ?
Got to see a neurologist got wait for me MRI scan
Will it ever go away ?
Need answers .

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Libbyalice said on 08 November 2013

I'm 18 and was diagnosed with TN a few months ago and have suffered with it since April this year. The pain has become a lot more severe over the past two months, a lot of the time resulting in tears. I can get it from twice to twelve times a day? I'm just wondering what's best for me to do and what you have all tried? I don't want to take the tablets that I have been prescribed because of the side effects. Please help! Thank you :)

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Katie Nizette said on 06 September 2013

Babs1972 - you need to get on the Chronic Pain listing to see a Specialist in this area. It may take time, but it's well worth the waiting. I'm a sufferer at this level and know what you are going through. I totally sympathise. Push, push and better push your GP to get seen to through this route.

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yokomotow said on 02 June 2013

Try using a gum shield at nite - it sure helped me

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sallyarmy said on 10 May 2013

ok, I am not in a lot of pain, just 2 out of 10. had MRI today, seeing consultant on Monday....symptoms; just like a bad injection in the crook of the jaw (not good at describing am I !!) for a filling affecting ear, nose, lips, and eye - feeling dry, sometimes feel 'it' in my neck! mostly on my left hand side of face... just uncomfortable... feeling anxious but they mentioned the trigeminal nerve - looked up this site... any ideas anyone? just taking paracetamol - not doing anything. just got some nurofen - hoping that will take 'it' away. reassurance needed or facts will be fine! x

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babs1972 said on 03 March 2013

I was diagnosed with TN2 (Atypical) a couple of years ago tried lots of different pills,none took all the pain away,
I started taking magnesium as read it can help & it did seem to....But now its back & no amount of magnesium is helping...back on nerve pills (pregabalin) ...took pills,but had to double up as prescribed dose did nothing.. ,pain has dulled, but very much still there & I feel drunk on these pills,cant walk straight... Hate this illness,it has reduced me to tears again today because the pain is so bad & constant ,,, I get the stabbing shock pains inside my head too... I know why they nick name it The suicide disease...wouldn't wish this on my worst enemy! Find a cure :(

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Yamazaki said on 02 February 2013

First diagnosed with TN2 ,Nov 2005.Took medication for 6 months , symptons disappeared until the end of 2011.
I am now having, assessing, Acupuncture, which, for me, does relieve symptoms for 2weeks or so.( I dont like the side effects of medication).

I have found the Trigeminal Neuralgia Association (UK) very helpful, giving me hope for the future.

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Just about had enough said on 22 January 2013

Had tn for 7 years now, no meds have even began to scratch the surface.

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Ladywriterwriter said on 17 December 2012

I have been diagnosed with this.

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