Trigeminal Neuralgia: Symptoms, Treatment and Practical Tips

Trigeminal neuralgia (TN) causes sudden, severe facial pain that feels like an electric shock. It usually affects one side of the face and can be triggered by simple things — shaving, chewing, a breeze, or even smiling. If you’ve had short, stabbing attacks of pain near the cheek, jaw, or eye, this is the type of problem to get checked quickly.

How to recognize it and when to see a doctor

TN attacks are brief (seconds to a couple of minutes) but can repeat many times a day. Between attacks you might feel fine, or you may have a dull ache. Warning signs to see a neurologist right away: growing frequency, longer pain episodes, weakness or numbness that doesn’t go away, or pain that doesn’t respond to first-line treatment. Also get a dental check if a tooth or jaw problem is suspected — TN is often mistaken for dental pain.

What usually causes trigeminal neuralgia and how it’s diagnosed

The most common cause is a blood vessel pressing on the trigeminal nerve at the brainstem. Other causes include multiple sclerosis or, rarely, a tumor. Doctors diagnose TN mostly from your story and a neurologic exam. An MRI is common to look for nerve compression or other causes. Expect questions about triggers, pain pattern, and medications you’ve tried.

Treatment starts gently and ramps up only if needed. The first-line medicine is carbamazepine — it often reduces or stops attacks quickly. Oxcarbazepine works similarly and may be better tolerated for some people. Other drugs used include gabapentin, pregabalin, and baclofen. All medicines can cause side effects, so monitoring blood levels and routine blood tests may be needed.

If meds don’t help or side effects are too bad, there are procedures. Microvascular decompression (MVD) moves the offending vessel off the nerve and can provide long-term relief, though it’s a surgery with risks. Less invasive options are percutaneous procedures (radiofrequency, balloon compression, glycerol injection) and radiosurgery (Gamma Knife). Radiosurgery is noninvasive but relief can take weeks to months.

Practical tips you can use right away: keep a pain diary (what triggered the attack, how long it lasted, what helped), avoid known triggers when possible, and carry fast-acting pain-relief plans if your doctor suggests them. Don’t try to self-dose opioids or mix meds without checking with a clinician. If a dentist suggests extractions for unexplained facial pain, get a second opinion — TN is commonly misdiagnosed as tooth pain.

Get care from a neurologist or a pain specialist who knows TN. Ask about imaging results, medication side effects, and procedure options. Join a support group or online forum to learn practical coping tips from others living with TN. If your pain is changing or getting worse, book an appointment now — starting the right tests and treatment early makes a big difference.