Trigeminal neuralgia

Trigeminal neuralgia is a long-term (chronic) condition that causes sudden, sharp and intense pain in your face. The pain may feel like an electric shock. It usually only affects one side of your face.

• Trigeminal refers to the trigeminal nerve.
• Neuralgia means nerve pain, which happens when a nerve is irritated or damaged.

Trigeminal neuralgia is also called 'tic douloureux'.

It can be challenging to live with chronic pain, but there are treatments that may help you.

The trigeminal nerve

Your nervous system is made up of a complex network of nerves. These nerves carry messages from different parts of your body to your brain. The trigeminal nerve is a large nerve in your head with 3 branches. They are responsible for sensation (feeling) in specific areas of your face.

The 3 branches of the trigeminal nerve are the:

• ophthalmic nerve — responsible for sensation in your eye, forehead and nose
• maxillary nerve — responsible for sensation in your upper teeth, gums, lip, cheek, lower eyelid and the side of your nose
• mandibular nerve — responsible for sensation in your lower teeth, gums and lip

Trigeminal neuralgia causes sudden, intense pain in the face. This pain can make daily life challenging. You may experience symptoms in one or more of the nerve branches.

Pain caused by trigeminal neuralgia is usually sudden, sharp and severe. Some people describe it as feeling like an electric shock.

It commonly affects only on one side of the face and follows the path of the trigeminal nerve.

Depending on which branch or branches of the nerve are affected, you might have pain in your:

• cheek
• jaw teeth
• gums
• lips
• forehead
• eye

Some people may feel slight numbness or tingling in the affected area. The pain can sometimes cause the muscles in your face to twitch or contract.

Attacks usually last several seconds, though they may last longer. They may occur several times a day or may come and go over weeks or months. Some people have periods where the pain disappears for a while (called remission). Others have constant pain that keeps coming back.

The pain may be triggered by:

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

Trigeminal neuralgia happens when the trigeminal nerve becomes irritated or damaged. This can cause the nerve to send pain signals to your brain, even without any injury or tissue damage to your face.

It is often caused by a blood vessel pressing on your trigeminal nerve, which can damage your nerve over time.

It can sometimes be caused by other conditions that affect your nerves, such as a tumour or multiple sclerosis.

Sometimes, no cause can be found.

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

Your doctor may diagnose trigeminal neuralgia by:

• asking about your symptoms
• performing a physical examination
• referring you for an MRI scan to check for blood vessels, tumours or other structures affecting your trigeminal nerve
• referring you for a CT scan, if an MRI isn't possible, to rule out other causes of your symptoms

Trigeminal neuralgia can sometimes feel similar to other head and neck problems, such as:

• tooth pain
• sinus issues
• temporomandibular (TMJ) joint dysfunction

Trigeminal neuralgia may be treated with medicines and sometimes surgery. The goal of treatment is to manage your pain and improve your quality of life.

Medicines

Medicines available for trigeminal neuralgia are:

• anticonvulsants (anti-seizure medicines) to calm the nerve and lessen pain signals
• muscle relaxants
• nerve pain medicines
• injections to reduce nerve pain

Speak with your doctor about which treatment may be best for you.

Surgery

Surgery may be appropriate if medicines don't relieve your symptoms. Common procedures include:

• microvascular decompression — moving or removing a blood vessel pressing on the trigeminal nerve
• radiofrequency therapy — where heat is used to block pain signals from the nerve
• balloon compression — where a small balloon is used to press on the nerve and stop pain signals

Other treatment options

Radiation therapy (Gamma Knife surgery) is a non-invasive procedure that uses focused radiation to reduce pain. It targets the nerve without invasive surgery.

For severe flare-ups, temporary treatments, such as local anaesthesia or intravenous medicines can provide short-term pain relief.

Living with trigeminal neuralgia can be challenging. There are steps you can take to manage your condition and improve your quality of life. Here are tips that may help you:

• Avoid triggers — learn what triggers your pain and develop strategies to manage triggers.
• Emotional support — reach out for help to deal with stress, anxiety or depression caused by the condition.
• See your doctor — to find treatments that control your pain.
• Stay active — try gentle activities, such as walking or stretching to stay healthy without causing pain.

Trigeminal neuralgia cannot always be be prevented because it often results from pressure on the nerve or other health problems.

If you have trigeminal neuralgia, you can reduce the chance of symptoms by avoiding triggers and managing other health conditions. This may help lessen your pain.

If you have symptoms, seek treatment early. This may help control your symptoms and stop them from getting worse.

• Trigeminal Neuralgia Association Australia offers resources and information about trigeminal neuralgia.
• Brain Foundation offers information about trigeminal neuralgia.
• If you need to talk to someone about your mental health, call Beyond Blue on 1300 22 4636.

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

Other languages

• The Multicultural Health Communication Service provides information about understanding pain in multiple languages.

Looking for information for Aboriginal and/or Torres Strait Islander people?

• Agency for Clinical Innovation offers information about long-term pain for Aboriginal and/or Torres Strait Islander people.
• If you, or someone you know, are feeling worried or no good, connect with 13YARN on 13 92 76.