Trigeminal Neuralgia
Also known as Tic douloureux
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is trigeminal neuralgia?
Trigeminal neuralgia causes sudden, severe, electric shock like pain in the distribution of the trigeminal nerve, usually in the cheek or jaw on one side. Attacks are brief but excruciating and are often triggered by light touch, chewing or cold air. It is frequently misdiagnosed as dental pain, leading to unnecessary extractions.
Causes
- Compression of the trigeminal nerve root by a blood vessel
- Demyelination, notably in multiple sclerosis
- Tumour compressing the nerve in rare cases
- Post traumatic or post surgical nerve injury
Symptoms
- Sudden severe stabbing or electric shock like facial pain
- Attacks lasting seconds to a couple of minutes
- Pain in the cheek, jaw, teeth or gums on one side
- Triggered by touch, chewing, talking, shaving or cold air
- Periods of remission followed by recurrence
- Pain free between attacks in classical cases
Risk factors
- Age over 50
- Female sex
- Multiple sclerosis
- Hypertension
Diagnosis
- Clinical diagnosis from the characteristic pain pattern
- MRI to identify vascular compression or exclude tumour and demyelination
- Neurological examination, typically normal in classical disease
- Dental assessment to exclude dental causes
Treatment
- Carbamazepine as first line medical therapy
- Oxcarbazepine as an alternative
- Lamotrigine or baclofen as add on options
- Microvascular decompression surgery for suitable patients
- Stereotactic radiosurgery
- Percutaneous rhizotomy procedures
- Avoiding known triggers during flares
Self care
- Identify and avoid personal triggers during flares
- Use lukewarm water and a soft toothbrush
- Protect the face from cold wind with a scarf
- Eat soft foods at room temperature during attacks
- Take carbamazepine consistently rather than only when in pain
- Keep a diary of attack frequency and triggers
- Seek psychological support, since severe pain affects mood
When to see a doctor
Book an appointment if:
- Facial pain that recurs in brief severe episodes
- Pain not controlled on current medication
- Troublesome side effects such as dizziness or drowsiness
- Attacks becoming more frequent
- Pain becoming constant rather than episodic
- Numbness developing in the face
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- Trigeminal neuralgia cannot be prevented
- Attacks are reduced by consistent medication rather than as needed use
- Avoiding known triggers reduces frequency during flares
- Treating multiple sclerosis where that is the underlying cause
Outlook
Carbamazepine controls pain effectively for most people initially, though effectiveness can decline and side effects limit dosing. Remissions lasting months or years are common. Microvascular decompression offers the best durable results, with the majority pain free afterwards and many remaining so for a decade or more.
Common questions
Why is it mistaken for toothache?
The pain often centres on the teeth and jaw, so people commonly seek dental care first. Unnecessary extractions are frequent, and the pain persists because the source is the nerve rather than the tooth.
How effective is carbamazepine?
It provides substantial relief for the large majority initially, and a good response supports the diagnosis. Effectiveness can decline over time, and blood monitoring is needed because of sodium and blood count effects.
Is surgery curative?
Microvascular decompression offers the best long term results, with most patients pain free afterwards and many remaining so for years. It is major surgery, so suitability depends on age, fitness and imaging findings.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.