Trigeminal Neuralgia

Trigeminal neuralgia is a chronic pain condition affecting the trigeminal nerve, which carries sensation from the face to the brain. It causes sudden, severe, brief episodes of facial pain, often triggered by ordinary activities such as chewing or touching the face.

• Sudden, severe, electric shock-like or stabbing pain, usually affecting one side of the face
• Pain typically lasts seconds to a couple of minutes per episode, but episodes can recur frequently throughout the day
• Often triggered by ordinary activities such as chewing, talking, brushing teeth, or a light touch to the face, or even a breeze on the face
• Between episodes, the person is usually pain-free, though some people experience a persistent background ache in more advanced cases

• Most commonly results from a blood vessel compressing the trigeminal nerve near where it exits the brainstem, causing irritation of the nerve.
• Less commonly, can result from other conditions affecting the nerve, such as multiple sclerosis.
• Most common in older adults, and slightly more common in women.

• Diagnosed primarily through a detailed clinical history of the characteristic pattern of pain — sudden, brief, severe, and typically triggered by specific activities.
• Brain imaging (MRI, where available) is often used to look for a blood vessel compressing the nerve or another underlying cause, particularly in younger patients or those with atypical features.

A specific anticonvulsant medicine (such as carbamazepine) is the first-line treatment and is highly effective for many people in controlling the pain, started at a low dose and gradually increased as needed.

Alternative or additional medicines may be used for people who do not respond adequately to the first-line option or who experience significant side effects.

For people whose pain is not adequately controlled with medicine, or who cannot tolerate it, referral to a specialist for consideration of a procedure — which may address the underlying vessel compression or the nerve itself — can provide longer-term relief.

Given the significant impact of the pain on eating, speaking, and daily life, prompt treatment and specialist referral when needed are important for quality of life.

• Seek prompt medical assessment for sudden, severe, brief facial pain triggered by touch or chewing, since effective treatment is available.
• Identify and, where possible, gently manage personal triggers while under treatment.
• Attend follow-up for medicine adjustment, as doses often need fine-tuning to balance pain control and side effects.
• There is no specific way to prevent trigeminal neuralgia, since the underlying vessel compression is not generally predictable or avoidable.