What is trigeminal neuralgia?
Trigeminal (try-GEM-in-ol) neuralgia (noor-
AL-ja) is a nerve disorder. With this disorder,
you get sudden bursts of very intense pain
on one side of your face. It is felt in the area
of your lips, gums, cheek, or chin. The pain
lasts only a few seconds or minutes, but it’s
so intense that you may wince. Some people
described the pain as lightening bolts, knife
thrusts, or electric shocks.
Another name for the disorder is tic (TICK)
douloureux (doo-luh-ROO), which means
“painful twitch.” Most people who develop
the disorder are over age 50, but younger
people can have it too. This disorder affects
more women than men.
What triggers the pain?
Triggers affect some people who have trigemi-
nal neuralgia. A trigger is anything that can
start or set off the pain. For example, lightly
touching your mouth or face, talking, eating,
drinking cold drinks, brushing your teeth, or
wind on your face may trigger pain. Some
people with trigeminal pain do not seem to be
affected by triggers.
What are the types of trigeminal
There are 3 types of trigeminal pain: typical,
atypical, and transitional.
• The pain is sharp, like an ice pick or
• The pain comes and goes for short or long
periods of time.
• The pain disappears for short or long
periods of time.
• The pain has triggers that you can identify.
• The pain can be burning, aching, or
throbbing, as well as sharp or stabbing.
• The pain may or may not disappear for
periods of time.
• The pain has no known triggers.
The pain is both typical and atypical.
What causes the nerve disorder?
The medical name for nerve pain is “neu-
ralgia.” Trigeminal neuralgia affects a large
nerve in the face called the trigeminal nerve.
The nerve becomes irritated, causing pain.
For example, an artery or a vein may be
pressing against the nerve. The blood ves-
sel may rub against the nerve each time the
heart beats. The repeated contact can start
to wear down the nerve’s protective cover-
ing. This can lead to periods of severe pain.
How is this disorder detected?
Your doctor will ask about your symptoms
and your overall health. You will have a
physical exam and a nerve exam. You also
may have MRI (magnetic resonance im-
aging) of your head to check for possible
causes of your face pain. The exams and test
may rule out other possible causes of your
pain. If so, your doctor may diagnose the
pain as trigeminal neuralgia, based on the
How is the disorder treated?
The ﬁrst treatment usually prescribed is
medicine. The drugs most often used are
anti-convulsants. These drugs help to reduce
trigeminal nerve impulses and so relieve
pain. Examples are carbamazepine (brand
name Tegretol), phenytoin (Dilantin),
oxcarbazepine (Trileptal), and gabapentin
(Neurontin). Over time, the pain may
become more severe. So the drug or its
dosage may need to be changed.
Surgery may be necessary if treatment with
drugs is not effective.
Microvascular decompression. An operation
called microvascular (my-crow-VAS-kyoo-ler)
decompression removes the pressure that is
against the nerve . During the operation, the
surgeon makes an incision behind the ear to
reach the trigeminal nerve. A small pad is then
placed between the trigeminal nerve and the
blood vessel pressing on it. The pad stops the
blood vessel from irritating the nerve. This
procedure usually gives long-term pain relief.
If pain continues, low-dose anti-convulsants
can help control pain. Sometimes repeating
the procedure gives relief.
Other surgical procedures. Another way to
reduce pain is to damage the trigeminal nerve.
The result is numbness in the area where the
pain was felt. Sometimes the numbness is per-
manent. Surgical procedures used include:
• glycerol injections — Shots are given under
the facial skin to numb the area.
• Gamma Knife surgery — A focused, high
dose of radiation is delivered to the
• electrocoagulation (ee-LEK-tro-ko-ag-
you-LAY-shun) — An electric current is
passed through an electrode to nerve ﬁbers.
• balloon compression — A tiny balloon at
the end of a very ﬁne tube is inserted and
then inﬂated against the nerve.
These procedures may relieve the pain for
years. They are an option for people with MS
(multiple sclerosis) or other health problems
that rule out microvascular decompression.
For more information
Other helpful resources include:
Trigeminal Neuralgia Association
2801 S.W. Archer Road, Suite C
Gainesville, FL 32608
American Chronic Pain Association
P.O. Box 850
Rocklin, CA 95677-0850