What is trigeminal neuralgia?

Trigeminal neuralgia is also called tic douloureux. It’s a type of neuralgia (nerve pain) that usually feels like a sudden stabbing or shocking pain.

This pain can be hard to live with. However, there are treatments available that can help.

The trigeminal nerve

Your nervous system involves a complex network of nerves. These nerves send impulses from different parts of your body to your brain. Trigeminal neuralgia involves one nerve called the trigeminal nerve. The trigeminal nerve is one of the largest nerves in your head. It sends messages to your:

• face
• jaw
• gums
• eyes
• forehead

What are the symptoms of trigeminal neuralgia?

The main symptom of trigeminal neuralgia is a sudden pain.

The trigeminal nerve has 3 nerve branches:

1. ophthalmic — eye, forehead and nose
2. maxillary — upper teeth, gums and lip, the cheek, lower eyelid and the side of the nose
3. mandibular — lower teeth, gums and lip

Trigeminal nerve pain can involve one or more of these nerve branches. The pain is usually felt on one side of your jaw or cheek.

The pain can be mild, especially when the condition first develops, but more often it’s:

• sharp
• shooting
• stabbing
• burning
• electric shock-like

Attacks tend to come and go, each usually lasting several seconds. Episodes can last for months at a time, repeating throughout the day.

Attacks can also disappear for long periods of time. Between attacks, people with trigeminal neuralgia might have:

• a dull ache in your face and jaw
• no pain at all

The pain can be triggered by:

• talking
• chewing
• swallowing
• eating hot or cold food or drinks
• brushing teeth
• touching your face
• stress

What causes trigeminal neuralgia?

Often, trigeminal neuralgia is caused by a blood vessel pressing on your trigeminal nerve. This damages your nerve over time, and stops it from working properly.

Occasionally, trigeminal neuralgia can be related to conditions such as:

• a stroke
• a tumour
• multiple sclerosis

Sometimes a cause can’t be found.

When should I see my doctor?

If you experience any symptoms of trigeminal neuralgia, see a doctor. They can diagnose the cause of your pain and provide you with treatment advice.

How is trigeminal neuralgia diagnosed?

Trigeminal neuralgia can sometimes feel a lot like other head and neck problems, such as:

• tooth pain
• temporomandibular joint dysfunction

To diagnose trigeminal neuralgia, a doctor might:

• examine you
• ask you about your symptoms
• see how you respond to anticonvulsant treatments such as carbamazepine

The doctor may also suggest you have an MRI scan to:

• help find the cause of your pain
• see whether surgery is needed

How is trigeminal neuralgia treated?

Trigeminal neuralgia can be treated in different ways. The main treatments for trigeminal neuralgia are medicine and surgery.

Medicines

Medicines available for trigeminal neuralgia are:

• anticonvulsants such as carbamazepine, gabapentin, clonazepam and valproic acid
• muscle relaxants such as baclofen
• antidepressants
• opioids
• capsaicin cream
• vitamin B12
• botulinum toxin (Botox)

Carbamazepine is the most commonly used treatment for trigeminal neuralgia. However, you should speak with your doctor about which treatment may be best for you.

Surgery

Surgery can be done to remove a blood vessel if it’s pushing on your trigeminal nerve.

Other techniques include, but are not limited to:

• glycerol injections, which coats your nerve in glycerol
• radiofrequency lesioning, which heats your nerve
• balloon compression, which presses on your nerve

These techniques deliberately damage or destroy your trigeminal nerve to stop the pain.

Surgical techniques involve some risks, such as:

• temporary or permanent numbness on your face
• hearing loss

If you decide to have surgery, talk to your surgeon about how they will monitor you during the procedure, to prevent complications.

Can trigeminal neuralgia be prevented?

Trigeminal neuralgia attacks can be prevented or lessened through treatment, and by avoiding triggers.

Complications of trigeminal neuralgia

Chronic pain caused by trigeminal neuralgia can be distressing. You may:

• have changes in your mood
• lose weight
• have trouble sleeping

Resources and support

The Trigeminal Neuralgia Association Australia has more resources and details of support groups for people with trigeminal neuralgia.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.