Trigeminal neuralgia

The trigeminal nerve (fifth cranial nerve) is one of the main nerves that supply your face. There is one on each side of your face.

They transmit pain and touch signals to your brain and control your jaw's muscle movements and the production of saliva and tears.

Each trigeminal nerve has 3 small branches:

• first or ophthalmic branch – this supplies your scalp, forehead and around your eye
• second or maxillary branch – this supplies your cheek
• third or mandibular branch – this supplies the area around your jaw. 

The exact cause of trigeminal neuralgia is not known but is thought to be caused by the compression of the trigeminal nerve. It then carries faulty messages to your brain and causes electric shock-like pain to your face.

The trigeminal nerve can be compressed or injured by:

• a blood vessel such as an artery or a vein – this is the most common cause
• a tumour or a cyst
• degenerative nerve condition such as multiple sclerosis
• facial injury
• surgery or dental procedures. 

People who are at higher risk of trigeminal neuralgia include:

• women
• people aged 50 years old or older
• people with high blood pressure
• people who get migraines.

Common symptoms of trigeminal neuralgia include:

• electric shock-like pain on one side of your face, although sometimes it may also affect both sides 
• pain that comes in sudden attacks that last for a few seconds to about 2 minutes, and can happen multiple times a day 
• minutes, hours or days between each attack
• pain that can be around your jaw or cheek or in your teeth
• pain that is sharp, electric shock-like, shooting, stabbing, piercing or knife-like
• pain that is so severe and excruciating that it affects your daily life
• a dull ache or burning feeling in between the pain attacks.

See your GP or doctor if you have any of the symptoms above. 

The pain attacks in trigeminal neuralgia can be triggered by certain actions or movements.

Sometimes you may not have a trigger for the pain attacks.

Your doctor will ask you questions related to your pain, including the pattern and location of your pain. Your doctor will also examine your face, including your ear, nose, throat, head and jaw.

There is no test to diagnose trigeminal neuralgia. It is diagnosed through your history and by ruling out other conditions. Blood tests may be needed as a baseline if your doctor is going to prescribe medicines. Sometimes, your doctor will also advise doing an MRI scan to find out the cause.

Trigeminal neuralgia can be treated in different ways depending on how bad the pain is and whether the cause is known. 

Carbamazepine is most commonly used to treat trigeminal neuralgia. This is medicine that is used to treat epilepsy, but can also be used to treat nerve pain. Read more about carbamazepine.

Other medicines that may be prescribed include:

• gabapentin
• pregabalin
• lamotrigine.

It can also help to identify and avoid triggers that are causing your pain, eg, if hot or cold drinks seem to be a trigger, you can try using a straw. 

In rare cases where medicines are unable to control the pain, surgery will be considered. Talk to your GP or doctor to find out the best treatment options for you. 

Botox injections have been tried, though there is not yet good evidence of its effectiveness.

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Trigeminal neuralgia varies from person to person. Episodes may last for weeks or months. This can be followed by pain-free intervals of weeks to years, although most remissions only last for a few months.

It's common for the condition to recur (come back). Some people find that the condition tends to come and go in terms of how severe it is and how often the pain flares up. 

People living with trigeminal neuralgia can feel distressed and have reduced quality of life. Talk through your feelings with your family/whānau and friends to get the support you need. You can also join a support group that shares information about trigeminal neuralgia such as Trigeminal Neuralgia NZ.(external link) 

There is also a Facebook page for trigeminal neuralgia support(external link) in New Zealand.

Balancing the benefits and risks of prescribing antiepileptic medicines in women(external link) BPAC, NZ, 2018
Managing patients with neuropathic pain(external link) BPAC, NZ, 2016

Video: Brain tumours and facial pain

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(Goodfellow Unit Webinar, NZ, 2020)

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