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Trigeminal Neuralgia: Symptoms, Causes and Treatment

Sandeep Dhanyamraju MD
Medically reviewed by Sandeep Dhanyamraju
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Sandeep Dhanyamraju MD
Medically reviewed by Sandeep Dhanyamraju

Neuralgia of the trigeminal nerve is a serious pathology that causes severe facial pain. It is otherwise called neuritis. In turn, neuralgia is pain along the course of the trigeminal nerve. It can act as an independent impairment of sensitivity. Although often inflammation accompanies it. Dental problems, other neurological disorders, and hypothermia can cause this disease.

Doctors associate the development of the pathology with damage to the trigeminal nerve. Neurologists can suspect the disease by the following symptoms:

  • intense burning pain on the right or left side of the face. It has an attack-like nature;
  • impaired sensitivity of the skin.

Trigeminal neuralgia usually affects adults. In children and adolescents, the disease is sporadic. Faced with the trigeminal neuralgia triggers, the person cannot lead a normal life. Thus, they often become temporarily unable to work.

Self-diagnosis of the pathology is extremely difficult because of the nonspecific symptoms. Because they are inherent to many diseases (e.g., dental). Thus, if you feel face discomfort, you should immediately consult a neurologist. Read the following article for more information about what can cause trigeminal neuralgia. Also, we will tell you how to diagnose and treat it.

What is Trigeminal Neuralgia?

Trigeminal neuralgia is one of the most common facial pains. It is among the most persistent pain syndromes in clinical neurology. The trigeminal nerve is the largest of the 12 cranial nerves. It belongs to the mixed type of nerve and includes susceptible fibers.

The nerve gets its name from the presence of three branches in it:

  • The oculomotor branch provides sensitivity to the forehead and eyes;
  • The maxillary branch provides sensitivity to the:
  • cheeks;
  • upper jaw;
  • upper lip;
  • palate;
  • The mandibular branch provides sensitivity to the lower jaw and lower lip. Also, it provides movement of the muscles involved in chewing and swallowing.

Everyone needs to know the early symptoms of trigeminal neuralgia. Trigeminal inflammation is a severe and chronic condition with remissions and exacerbations. Doctors describe it as having episodes of intense, shooting pain in the face.

Trigeminal neuralgia is more difficult to treat than other types of chronic pain. It also leads to temporary or permanent disability. This makes it a significant economic and social problem. Vascular, endocrine exchange, and immunological factors are in the pathogenetic mechanisms. 

The sensitivity of the nuclei changes because of them. You can also have the focus of pathological activity in the central nervous system. After that, trigeminal neuralgia triggers cause facial pain attacks. It occurs in the innervation of various nerve branches:

  • The vascular factor takes part in classic neuralgia. At this point, a vertically crossed arterial loop affects the nerve root.
  • Doctors especially focus on endocrine-exchange conflict (nerve-vessel conflict). It occurs in people whose arteries and nerve fibers begin to sclerose. It is the most common cause in the elderly with trigeminal neuralgia.
  • Autoimmune processes cause inflammatory reactions with dental treatment and colds. In this case, it is what causes trigeminal neuralgia and pain.

Early Symptoms of Trigeminal Neuralgia

The main symptoms of trigeminal neuralgia are sharp, stabbing pain. They spread from the face to the side (temporal) of the head (right or left). The pain is very intense but, more often, short-lived. Pain with trigeminal neuralgia can occur in different parts of the face. It all depends on which nerve branch has pain:

  • Maxillary. It usually occurs in the facial muscles, upper jaw, and nose.
  • Mandibular. It is a pain that will resemble a toothache.
  • Ocular. You can feel it in the temples, forehead, and above eyebrows.

symptoms of trigeminal neuralgia

Otherwise, trigeminal pain can be long-lasting for up to several days. Most often, the pain is localized on one side of the head. So it is easier to find trigeminal neuralgia triggers. Facial pain can occur spontaneously, or you can provoke it:

  • facial expressions;
  • brushing your teeth;
  • touching certain areas of the face (trigger points).

Typical signs of pain syndrome in trigeminal neuralgia include:

  • the character of facial pain – acute, short-term, intense;
  • the duration of the attack – from 10 seconds to 2 minutes;
  • localization of pain and its direction always remaining unchanged;
  • involuntary convulsions of masticatory and facial muscles at the peak of pain sensations. 

Their frequency varies from single cases to dozens or even hundreds a day. The attacks become more frequent during exacerbations (more often in the cold season). So it is important to determine what can cause trigeminal neuralgia.

During the remission period, patients live in fear. They fear an exacerbation of the disease and cover their heads even in the summer. Patients fear not touching the diseased half of the face. They also do not brush their teeth or chew on the affected side. Several early symptoms of trigeminal neuralgia can state:

  • facial muscle spasms;
  • increased salivation;
  • increased or decreased sensitivity of the facial skin;
  • moderate increase in temperature;
  • weakness and pain of the facial muscles.

Atypical trigeminal neuralgia is less common. It causes a less intense but constant dull burning or aching pain.

Trigeminal Neuralgia Triggers

The trigeminal nerve can suffer trauma:

  • fractures;
  • tissue tears;
  • unprofessionally administered conduction anesthesia. 

It can also break due to the destruction of the myelin sheath of the nerve itself. It is a typical problem for patients with sclerosis. But more often, we talk about the pathology’s inflammatory nature.

The most common causes leading to damage to the trigeminal nerve are:

1. Compression of the trigeminal nerve as a whole or its branches in the background.

2. Viral lesions directly on the nerve: herpes, polio, AIDS.

3. Atherosclerosis. It is a disease involving impaired blood circulation in the blood vessels of the brain.

4. Abnormal location of cerebral vessels. So they can pinch the nerve and lead to damage to the trigeminal nerve.

5. Dental problems

  • complications after root canal filling;
  • specific reactions to the introduction of anesthetics;
  • periostitis and other inflammatory diseases.

6. Multiple sclerosis. It is a complex pathology of nerve myelin sheath destruction.

7. Aneurysm. An aneurysm is an area of enlargement of one of the arteries in the cranial cavity. A dilated artery can pinch the trigeminal nerve, causing unpleasant symptoms.

8. Overcooling of tissues in the facial area. Hypothermia results in poor circulation with the stagnation of venous blood. There is also a slowing down of the metabolism in certain areas.

Risk Factors of Trigeminal Neuralgia

The risk of developing trigeminal neuralgia is greatly increased:

  • over the age of 50;
  • mental disorders;
  • regular hypothermia;
  • insufficient intake of nutrients and vitamins (anorexia, bulimia, malabsorption, etc.);
  • regular overexertion, stress;
  • worm infestations and other helminth infestations;
  • acute infections: malaria, syphilis, botulism, etc.;
  • chronic inflammation in the oral cavity (caries, gingivitis, abscesses, etc.);
  • in the background of autoimmune lesions;
  • in overexposure to allergies;
  • metabolic disorders.

Trigeminal neuralgia is an independent disease. Compression of a nerve root by neighboring tissues can cause damage to the trigeminal nerve. It can also be a symptom indicating pathology in neighboring tissues and vessels. 

Over time, trigeminal inflammation symptoms can lead to neuropathic complications. They can also lead to developing a secondary pain syndrome in the head. Patients with nerve disease use only the healthy half of their mouth when chewing food. As they are afraid to cause trigeminal neuralgia triggers. It results in: 

  • the formation of muscle thickening;
  • loss of sensation in the affected half of the face.  

In the chronic form of the disease, the auditory and facial nerves have severe pain. Without treatment, trigeminal neuralgia can lead to more serious complications:

  • dystrophy of the masseter muscles;
  • decreased sensation in the affected area;
  • contracture and spontaneous contraction of the facial muscles;
  • conjunctivitis.

How Trigeminal Neuralgia Diagnosed?

It is possible to determine this disease by tomography, CT scan or angiography, and other methods. Only after the interview can the physician distinguish damage to the trigeminal nerve from:

  • Schostad’s syndrome;
  • postherpetic pain;
  • typical migraine

Because in this syndrome, the attacks are more prolonged. But, to understand the full picture, it is important to make a comprehensive diagnosis:

Name  Description
Tomography For an accurate diagnosis and proper treatment assignment, it is crucial to:

  • complete data on the condition of the brain;
  • the choice of detailed circuitry.

The circuitry is vital for accurate positioning for an MRI of the trigeminal nerve. MRI with contrast provides the most accurate data.

Trinitarian nerve scans It makes it possible to create layer-by-layer images. Doctors can also detect neurovascular conflict and signs of nerve myelin sheath destruction. The scan lets the doctor get a complete picture of the examined nerve. It is essential to know what can cause trigeminal neuralgia. They can also find out what is happening when it exits the brainstem.
CT scan It is essential that CT scanning allows us to detect a neurovascular conflict. It also helps to understand its cause. It could be a conflict of the cerebellar arteries or a neuroma (neoplasia) of the nerve. Often, the trigeminal nerve is scanned with a simultaneous scan of the facial nerve.
X-rays of the jaws If the doctor assumes the main problem concerns the teeth.
Angiography It is crucial to verify the vascular genesis of the compression. Especially if the aneurysm and the vascular loop or aneurysm are large.

Blood and urine tests are also prescribed in most cases of damage to the trigeminal nerve (especially the role of these tests is valuable in pathologies resulting from infectious diseases).

Treatment of Trigeminal Neuralgia 

Treatment is aimed at controlling the pain syndrome. Also, it can prevent the recurrence of the disease:

  • in the milder course of the disease, medication can help;
  • in advanced stages, extensive areas of surgical lesion treatment are used. It also helps to overcome the nature of the trigeminal neuralgia triggers.

treatment for trigeminal neuralgia

In the non-acute phase, therapeutic baths, massages, acupuncture, and paraffin therapy are useful. Surgical operations are the most effective for fighting trigeminal neuralgia. They allow not only eliminate the pain but also cut the chain of impulsion to affect the conflict between the cranial nerve root coming out of the brain stem and the vessel that adjoins it. Medication therapy can often show good results in reducing early symptoms of trigeminal neuralgia. Doctors prescribe the following medications:

  • Drugs to control symptoms. They relieve pain in 70-80% of patients with trigeminal neuralgia.
  • Antispasmodics and myorelaxants of central action. They are some of the common drugs in this situation.
  • Alcohol blockades are good at “freezing” the affected area of the face. The effect of the blockage is there, but it is short-lived. Therefore, such injections are most often used as a temporary measure.
  • Anticonvulsants. They help slow down the process of transmission of nerve impulses.
  • B vitamins. They have a neurotropic effect (they improve mediator metabolism and have some analgesic activity, so they increase the effect of painkillers).

Physiotherapy techniques are also used to treat damage to the trigeminal nerve. But most doctors are inclined to the fact that they are effective as auxiliaries. They enhance the effect of conservative medications. And doctors can also use them after surgery in the rehabilitation stage. For example, drug treatment at the acute stage is effective to combine with:

  • light therapy, especially infrared ray therapy in small doses;
  • phonophoresis;
  • electrophoresis;
  • darsonvalization. 

Consult the Best Neurologists from Lone Star

When early symptoms of trigeminal neuralgia appear, you should immediately see a neurologist. Because timely diagnosis is crucial in the treatment of neurological pathologies. Contact our Lone Star Neurology clinic for help. Because we have the best neurologists in our clinics.


  • How do you get trigeminal neuralgia?

The most common triggers include trigeminal nerve impingement (trauma to the temporomandibular joint, congenital anomalies in the bone structures of the skull, tumors of the brain and facial area, abnormal vessel enlargements, etc.).

  • Does trigeminal neuralgia cause swelling?

Yes, swelling is one of the accompanying symptoms. You can get rid of it by applying an anti-inflammatory ointment to the pain area. You can also make a warming compress.

  • How common is trigeminal neuralgia?

The prevalence of trigeminal neuralgia (NTN) is relatively high, with up to 30 to 50 patients per 100,000 population, and the incidence, according to WHO, is between 2 and 4 per 100,000 population. NTN occurs more often in women aged 50-69 and has a right-sided localization.

  • How do you calm down trigeminal neuralgia?

To relieve pain, you can use cognitive behavioral therapy, biofeedback, relaxation techniques, and medications such as anti-seizure drugs or tricyclic antidepressants. Your doctor can help you determine the best approach for your individual situation. Avoid drafts and being out in the cold.

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Edward Medina
Edward Medina
15:34 30 Jun 22
Just such an amazing staff that makes you feel like part of their family. I’ve been going there for over 5 years now... and each visit I get the very best care and treatments that I have ever received in the 20+ years that I’ve been dealing with severe debilitating migraines. Since i started seeing them the number of my migraines has dropped from 15-20 a month to 2-3 every 3 month. I highly recommend them …they will change your life!read more
Daneisha Johnson
Daneisha Johnson
22:20 19 May 22
Dr. Askari was very kind and explained everything so I could understand. The other staff were nice as well. I would... have gave 5 stars but I was a little taken aback when I checked in and had to pay 600.00 upfront. I think that should have been discussed in a appointment confirmation call or email just so I could have been more
Jean Cooper
Jean Cooper
16:54 29 Apr 22
I love the office staff they are friendly and very helpful. Dr. JODIE is very caring and understanding to your needs... and wants to help you. I will go back. would recommend Dr. Dr. Jodie to other Patients in a heart beat. The team works well more
Linda M
Linda M
19:40 02 Apr 22
I was obviously stressed, needing to see a neurologist. The staff was so patient and Dr. Ansari was so kind. At one... point he told me to relax, we have time, when I was relaying my history of my condition. That helped ease my stress. I have seen 3 other neurologists and he was the only one who performed any assessment tests on my cognitive and physical skills. At one point I couldn't complete two assessments and got upset and cried. I was told, it's OK. That's why you're here. I was truly impressed, and super pleased with the whole experience!read more
Leslie Durham
Leslie Durham
15:05 01 Apr 22
I've been coming here for about 5 years. The staff are ALWAYS friendly and knowledgeable. The Doctors are the absolute... best!! Jodie Moore is always in such a great mood which is a plus when you are already stressed. Highly recommendedread more
Monica Del Bosque
Monica Del Bosque
14:13 25 Mar 22
Since my first post my thoughts have changed here. It's unfortunate. My doctor and PA were great, but the office staff... is horrible. They never call you back when they say they will, they misinform you, they cause you too much stress wondering what's going on, they don't keep you posted. They never answer the phone. At this point I've left four messages in the last week, and I have sent three messages. Twice from their portal and one direct email. No response. My appointment is on Monday morning at 8:30am, no confirmation on my insurance and what's going on. What the heck is going on, this is ridiculous!I've given up... the stress her office staff has put me through is just not worth it. You can do so much better, please clean house, either change out your office staff, or find a way for them to be more efficient please. You have to do something. This is not how you want to run your practice. It leaves a very bad impression on your more
Ron Buckholz
Ron Buckholz
23:32 23 Mar 22
I was actually pleasantly surprised with this visit! It took me a long time to get the appointment scheduled because no... one answers your phones EVER! After a month, I finally got in, and your staff was warm, friendly, and I was totally impressed! I feel like you will take care of my needs!read more
Steve Nabavi
Steve Nabavi
16:28 16 Mar 22
It was a nice visit. Happy staff doing all they can do to comfort the patients in a very calming environment. You ask... me they are earned a big gold star on the fridge. My only complaint they didn't give me any more
Katie Lewis
Katie Lewis
16:10 10 Feb 22
Had very positive appointments with Jodie and Dr. Sheth for my migraine care. Jodie was so fast with the injections and... has so much valuable info. I started to feel light headed during checkout and the staff was SO helpful—giving me a chair, water, and taking me into a private room until I felt better. Highly recommend this practice for migraine patients, they know what they’re doing!!read more
Joshua Martinez
Joshua Martinez
16:02 10 Dec 21
I was scheduled to be checked and just want to say that the staff was fantastic. They were kind and helpful. I was... asked many questions related to what was going on and not once did I feel as though I was being brushed off. The front desk staff was especially great in assisting me. I'm scheduled to go back for a mri and am glad that I'll be going more
Isabel Ivy
Isabel Ivy
21:42 03 Nov 21
I had such a good experience with Lone Star Neurology, Brent my MRI Tech was so awesome and made sure I was very... comfortable during the appointment. He gave me ear plugs, a pillow, leg support and blanket, easiest MRI ever lol 🤣 My 72 hour EEG nurse Amanda was also so awesome. She made sure I was take care of over the 3 days and took her time with the electrodes to make sure it was comfortable for me! Paige was also a huge help in answering all my questions when it came to my test results, and letting me know her honest opinions about how I should go forth with my more
Leslie Luce
Leslie Luce
17:37 20 Oct 21
The professionalism and want to help attitude of this office was present from the moment I contacted them. The follow... up and follow through as well as their willingness to find a way to schedule my dad was above and beyond. We visited two offices in the same day with the same experience. I am appreciative of this—we spend a lot of time with doctors and this was top notch start to more
robert Parker
robert Parker
16:38 16 Apr 21
I love going to this office. The staff is friendly and helpful. The doctor is great. I am getting the best... neurological tests and treatment I have ever had. The only reason I did not give them a 5 star rating is because it is impossible to reach a live person at the office to reschedule appointments. Every time I have tried to get through to the office it says all people are busy and I am sent to a voicemail. If they could get their phone answering fixed, I would give them a strong 5 more
MaryAnn Hornbaker
MaryAnn Hornbaker
00:26 25 Feb 21
Dr. Harney is an excellent Dr. I found him friendly , personable and thorough. I evidently am an unusual case. ... Therefore he spent a Hugh amount of time educating me. He even gave me literature to further explain my condition and how to follow up. This is something you rarely get from your doctors. So I am more than please with my doctor and his more
Roger Arguello
Roger Arguello
03:05 29 Jan 21
Always courteous, professional. The staff is very friendly and always work with you to find the best appointment time.... The care team has been great. Always taking the time to listen to your concerns and to find the best more
Margaret Rowland
Margaret Rowland
01:12 27 Jan 21
I have been a patient at Lone Star Neurology for several years. Now both my adult daughters also are patients there. I... love Jodie. She is always so prompt whether it is a teleamed call are a visit in the office. She takes the time to explain everything to me and answers all my questions. I am so blessed to have Jodie as my more
Susan Miller
Susan Miller
03:01 13 Jan 21
My husband had an accident 5 years ago and Lone Star Neurology has been such a blessing to us with my husbands care.... Jodie Moore is his provider and she is amazing! Jodie is very knowledgeable, caring, and thorough. She takes her time with you, making sure your needs are met and she is happy to answer any questions you may have. Lone Star Neurology’s patients are very lucky to have Jodie providing their care. Thank you Lone Star Neurology and especially Jodie for everything you have done for us. Jodie, you are the best!read more
Windalyn C
Windalyn C
01:32 09 Jan 21
Jodie is wonderful. She is very caring and knowledgeable. I have been to over a dozen neurologists, and none were able... to help me as much as they have here. Thanks!read more
Katie Kordel
Katie Kordel
00:40 09 Jan 21
Jodi Moore, nurse practitioner, is amazing. I have suffered from frequent, debilitating headaches for almost 20 years.... She has provided the best proactive and responsive care I have ever received. My quality of life has been greatly improved by her caring approach and tenacity in finding more
Ellie Natsis
Ellie Natsis
15:41 07 Jan 21
I have had the best experience at this neurologist's office! For over a year I have been receiving iv treatments here... each month and my nurse, Bobbie is beyond wonderful!! She's so attentive, knowledgeable, caring, and detail oriented. She makes an otherwise uncomfortable experience much more pleasant and definitely puts me at ease! She also helps me with my insurance,ordering this specialty medication and dealing with the ordering process which is no easy feat.Needless to say, she goes above a beyond in every way and I'm so grateful to this office and to Bobbie for all they do for me!read more
Matt Morris
Matt Morris
15:39 07 Jan 21
Let me start by saying that I have been coming here for years. Due to my autoimmune disease, I am in this office... once every three weeks for multiple hours at a time. The office is very clean and the staff very friendly. My only complaint would be there communication via phone. They aren't the best at responding if you leave a voicemail and expect a call back. I understand that this is prob just due to the sheer number of alls they receive daily. What I can say I like the best about the office are the people. Bobby who handles my infusions is great. I never have any issues with her setting up my infusions. She is very quick to reply to messages sent via text and if she were to leave then my whole opinion of the office may change. I also enjoy people like Matt, Lauren, and Jodi. I appreciate all that they do for me and without this team I'm not sure I would be as happy as I am to visit the office as frequently as I have to. Please ensure that these folks are recognized as they are what makes my visit to this office so tolerable :).read more
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