Even seemingly harmless activities, such as talking, chewing, wearing a mask or washing your face, can trigger intense pain episodes, explains Dr. Maggie Waung, a Jan and Maria Manetti Shrem Endowed Professor and physician at the General Neurology and Trigeminal Neuralgia Clinics, director of the neurology complex diagnosis clinic at University of California–San Francisco, division chief of general neurology, and an associate professor of neurology within the UCSF Weill Institute for Neurosciences.
Because the involved nerves are compromised, “even a light wind blowing on your face can trigger this brief, often electric shock-like pain,” Waung adds.
To avoid triggering painful symptoms, people with trigeminal neuralgia may take extreme measures, such as limiting movement, avoiding basic hygiene like brushing their teeth, minimizing chewing or staying indoors.
Trigeminal neuralgia causes
Reasons for trigeminal neuralgia include:
- Compression of the trigeminal nerve by an artery in the brain, called neurovascular compression
- Facial trauma
- Nerve compression from a tumor
- Multiple sclerosis
Patients with multiple sclerosis have a 20-fold increased risk of developing trigeminal neuralgia. It affects up to 5% of patients with MS and often affects older people, according to a 2019 study.
Oftentimes, however, the cause is unknown or idiopathic.
Trigeminal neuralgia symptoms
The trigeminal nerve carries sensory information from the face via three branches – above the eyebrow, along the cheek and at the chin level. Trigeminal neuralgia interrupts that nerve flow, causing symptoms such as:
- Sudden facial pain – often described as an “electric shock-like” jolt
- Localized pain, usually on just one side of the face
- Painful episodes lasting seconds to several minutes
Trigeminal neuralgia treatment
Certain treatments can ease or even cure trigeminal neuralgia pain, depending on the cause:
- Medication. Carbamazepine (Tegretol), which is also an anti-seizure medication, is the only treatment approved explicitly for trigeminal neuralgia pain by the Food and Drug Administration. Carbamazepine acts on sodium channels in the cells to prevent pain-related nerves from firing. Other anti-seizure drugs, like oxcarbazepine (Trileptal), gabapentin and phenytoin (Dilantin), are also effective for some patients.
- Surgery. Microvascular decompression involves an invasive surgical procedure to gently separate the blood vessel from where it’s pressing on the trigeminal nerve in the brain.
- High-dose radiation. Gamma knife radiosurgery directs high-dose radiation to the trigeminal nerve root. This minimally invasive option helps numb the nerve so it’s not continually sending pain signals.
“We always start off with medications,” Waung says. “When people aren’t doing well on medications, we’ll consider surgical options.”
Before considering surgery, patients are first thoroughly evaluated to determine if they’re appropriate candidates, particularly for more invasive procedures.
6. Post-surgery pain and recovery
