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Trigeminal neuralgia

Trigeminal neuralgia is a pain condition affecting the trigeminal nerves.

Everyone has two trigeminal nerves, one on each side of the face. Each one controls the sensation (feeling) on that side of the face.

Each nerve starts at the skull above the ear, then travels around the side of the face as three separate branches.

Sometimes, the messages from the nerves are faulty, which causes short, but intense electric shocks to the face. This is called trigeminal neuralgia.

Usually, only one side of the face is affected. The electric shocks can be triggered by hair brushing, a breeze blowing on the face, chewing food, brushing the teeth, talking, or other mild stimulation. The pain comes in waves or bouts, and these attacks can occur hundreds of times per day, or just now and again.

The pattern of pain depends on which branch of the nerve is effected. The three branches of the nerve are the ophthalmic (which supplies sensation to the forehead and nose), the maxillary (which supplies the cheek above the mouth) and mandibular (which supplies the jaw, the temple and in front of the ear).

Most commonly, the lower branches of the nerve (maxillary or mandibular) are affected. If the ophthalmic branch is affected there may also be associated runny nose, tearing, or reddening of the eye.

Usually, the pain goes away when the attack is finished. Some people feel a dull ache which remains between attacks.

Causes of trigeminal neuralgia

Sometimes, trigeminal neuralgia develops after an injury to the nerve. This can include inflammation, a knock to the side of the face, or having a tooth pulled out by a dentist. Most often, it develops as a result of compression inside the brain by a loop of a blood vessel. Occasionally, the compression is due to a tumour.

It affects women more often than men, and is more likely to occur over the age of 50. People who have high blood pressure, or get migraines seem to be at higher risk than others of developing trigeminal neuralgia.

Some people have a more severe problem with their trigeminal nerve called trigeminal neuropathy. This involves continuous pain in the area of the trigeminal nerve. This is unlike trigeminal neuralgia, where the pain comes and goes. The most common causes of trigeminal neuropathy are injury to the nerve (facial trauma), or having shingles.

There are no tests for trigeminal neuralgia. A GP can diagnose it after taking a history of the problem and performing an examination.

Treating trigeminal neuralgia

Treatment for trigeminal neuralgia usually involves taking a daily medication to reduce painful messages that the nerve is sending to the brain.

The most effective medication for trigeminal neuralgia is carbamazepine. It's usually used for treating epilepsy but is also effective at treating nerve pain. There are also other options if this is ineffective.

Some people don't get better with medication and need surgery to remove the compression. Talk to your GP about whether this might be an option for you. Because medications are usually safer, surgery is unlikely to be offered unless medication is ineffective.

For most people, trigeminal neuralgia comes and goes in an unpredictable pattern over many years. This can mean days, or months of spasms of pain followed by long periods without pain.

Because the pain tends to be very severe in nature when it does happen, most people seek medical help.

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Written by HealthInfo clinical advisers. Last reviewed September 2019.

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