Facial pain with fever, rash, weakness or visual loss needs urgent assessment. Also seek prompt care if you cannot eat or drink because of the pain, since dehydration follows quickly.
Sudden, severe, electric-shock-like pain in the face, triggered by touching the skin, chewing, speaking or a breath of cold air. It is among the most severe pains in medicine, and it is treatable.
Many patients arrive having had several teeth removed for pain that was never dental. Recognising the pattern early prevents that, and the treatments available are genuinely effective.
The trigeminal nerve carries sensation from the face. In most cases of trigeminal neuralgia, a small artery or vein lies against the nerve where it emerges from the brainstem, and the pulsation gradually wears away its insulating sheath. The exposed nerve fires abnormally, producing bursts of severe pain.
The pain is characteristic and distinguishable from most other facial pain. It is sudden, sharp, electric or stabbing, lasts seconds to a couple of minutes, and comes in volleys. Between attacks there is typically no pain at all, at least early in the condition. It affects one side, most often the cheek or jaw.
Trigger zones are the hallmark. Light touch on a specific patch of skin, chewing, brushing teeth, shaving, cold air or even speaking can set off an attack. Patients often avoid washing that side of the face, and weight loss from avoiding eating is common.
In a minority, particularly younger patients or where both sides are affected, an underlying cause such as multiple sclerosis or a tumour compressing the nerve is responsible. This is why an MRI should always be performed rather than assumed unnecessary.
Because the pain is felt in the jaw and cheek, trigeminal neuralgia is regularly mistaken for dental disease, and it is common to meet patients who have had several healthy teeth extracted before the diagnosis was made. Dental treatment does not help and the extractions are irreversible. The distinguishing features are that the pain is electric rather than throbbing, lasts seconds rather than being continuous, is triggered by light touch rather than by hot or cold food, and typically responds to carbamazepine. If your dentist can find no cause, ask for a neurological opinion before any further extraction.
The diagnosis is clinical; imaging looks for a cause and plans treatment.
Tell us exactly what the pain feels like, how long each attack lasts, what triggers it, whether there is pain between attacks, and which part of the face is affected. Add whether carbamazepine has been tried and at what dose, and whether it helped. That description, with an MRI, is enough for a specialist to form a firm view before you travel.
Medication controls the pain in most patients initially, and surgery is for when it stops working or cannot be tolerated.
Carbamazepine is the first-line treatment and is effective in the great majority of patients initially. Oxcarbazepine is an alternative with fewer interactions. Ordinary painkillers, including strong opioids, do not work for this pain — that lack of response is itself characteristic.
Through a small opening behind the ear, the offending vessel is separated from the nerve and a small pad placed between them. It treats the cause rather than damaging the nerve, and produces the most durable results — the majority of patients remain pain-free long term with sensation preserved. It is an operation inside the skull with the corresponding risks.
Focused radiation delivered to the nerve in a single session with no incision. Pain relief develops over weeks to months rather than immediately, and a proportion of patients develop some facial numbness. It suits older patients, those unfit for surgery, and anyone who prefers to avoid an operation.
A needle passed through the cheek to the nerve, which is then damaged in a controlled way by heat, glycerol or balloon compression. Relief is immediate and the procedure is quick and repeatable, but numbness is usual and recurrence is more common than after decompression.
Carbamazepine at an adequate dose. Many patients are on too low a dose or have been given ordinary painkillers, which do not work for this pain.
Microvascular decompression offers the most durable relief and preserves sensation, but it is an intracranial operation. Radiosurgery and percutaneous procedures are less invasive with somewhat less durable results.
Vascular contact supports decompression. An underlying tumour or multiple sclerosis changes the approach entirely.
If you have not had an adequate trial of carbamazepine, we will suggest that first. It is inexpensive, available everywhere, and controls the pain in most patients.
Trigeminal neuralgia is rarely an emergency, but pain severe enough to prevent eating and drinking needs prompt local treatment before travel.
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Almost certainly not, if the pain is electric and lasts seconds, is triggered by light touch or cold air, and does not respond to ordinary painkillers. Dental pain is typically throbbing, continuous, and worse with hot or cold food. Trigeminal neuralgia is frequently misdiagnosed as dental disease, and teeth are removed unnecessarily. If your dentist finds no cause, seek a neurological opinion before further extraction.
Because this is nerve pain generated by abnormal firing rather than tissue damage, and ordinary analgesics including opioids act on a different mechanism. Carbamazepine works by stabilising the nerve membrane. The failure of conventional painkillers is itself a useful diagnostic clue.
Microvascular decompression. Because it addresses the cause by lifting the vessel off the nerve rather than damaging the nerve, the majority of patients remain pain-free long term with sensation preserved. It is an intracranial operation, so it suits patients fit enough for it. Radiosurgery and percutaneous procedures are less invasive with somewhat higher recurrence.
After microvascular decompression, usually not — preserving sensation is one of its advantages. After radiosurgery a proportion of patients develop some numbness, and after percutaneous procedures numbness is expected as part of how they work. This trade-off between relief and sensation should be discussed before choosing.
It can, with any treatment. Recurrence is least common after microvascular decompression and more common after procedures that damage the nerve. Recurrence does not mean nothing more can be done — medication frequently works again, and procedures can often be repeated.
Yes, it does. Trigeminal neuralgia in a younger patient, or affecting both sides, raises the possibility of multiple sclerosis or an underlying structural cause, and an MRI is essential rather than optional. The treatment approach differs where an underlying condition is found, so this should be established first.
Describe the pain precisely — how long each attack lasts, what triggers it, and whether there is pain in between. That description is most of the diagnosis.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
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