What symptoms occur with trigeminal neuralgia?
Neuralgia means pain coming from a nerve. In trigeminal neuralgia you have sudden pains that come from one or more branches of the trigeminal nerve. The pains are usually severe. The second and third branches are the most commonly affected. Therefore, the pain is usually around your cheek or jaw or both. The first branch is less commonly affected, so pain over your forehead and around your eye is less common. Trigeminal neuralgia usually affects one side of your face. Rarely, both sides are affected.
The pain is stabbing ('like electric shocks'), piercing, sharp, or knife-like. It usually lasts a few seconds but can last up to two minutes. The pain can be so sudden and severe that you may jerk or grimace with pain. The time between each pain may be minutes, hours, or days. Sometimes the pain is repeated in quick succession. After an attack of pain, you may have a dull ache and tenderness over the affected area, which soon eases. However, constant pain in the face is not usually a feature of trigeminal neuralgia.
You may have trigger points on your face where a touch or even a draught of air can trigger a pain. These are often around the nose and mouth. Because of these, some people do not wash or shave for fear of triggering a pain. Eating, talking, smoking, brushing teeth, or swallowing may also trigger a pain. Between attacks of pain, there are usually no other symptoms, the nerve works normally and a doctor's examination would find no abnormality.
How does trigeminal neuralgia progress?
The first attack of pain usually occurs without warning and for no apparent reason. Further pains then come and go. The frequency of the pains varies from up to a hundred times a day, to just an occasional pain every now and then. This first bout (episode) of pains may last days, weeks, or months and then, typically, the pains stop for a while.
Further bouts of pain usually develop at some time in the future. However, several months or even years may pass between bouts of pains. It is impossible to predict when the next bout of pains will occur, or how often the pain will come back. Bouts of pain tend to become more frequent as you become older.
Therefore, a typical person with trigeminal neuralgia is an older person, has classic symptoms (as described above), has no other symptoms to suggest an underlying disease such as multiple sclerosis, and finds that treatment works well.
Further reading and references
Trigeminal neuralgia; NICE CKS, December 2014 (UK access only)
Deep brain stimulation for intractable trigeminal autonomic cephalalgias; NICE Interventional Procedure Guideline, March 2011
Montano N, Conforti G, Di Bonaventura R, et al; Advances in diagnosis and treatment of trigeminal neuralgia. Ther Clin Risk Manag. 2015 Feb 2411:289-99. doi: 10.2147/TCRM.S37592. eCollection 2015.
Zakrzewska JM, Linskey ME; Trigeminal neuralgia. BMJ. 2014 Feb 17348:g474. doi: 10.1136/bmj.g474.
Zhang J, Yang M, Zhou M, et al; Non-antiepileptic drugs for trigeminal neuralgia. Cochrane Database Syst Rev. 2013 Dec 312:CD004029. doi: 10.1002/14651858.CD004029.pub4.
Parmar M, Sharma N, Modgill V, et al; Comparative Evaluation of Surgical Procedures for Trigeminal Neuralgia. J Maxillofac Oral Surg. 2013 Dec12(4):400-409. Epub 2012 Nov 29.
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