Trigeminal Neuralgia

Trigeminal neuralgia is a condition that causes sudden, severe facial pain, usually on one side of the face. The pain comes from irritation of the trigeminal nerve, which provides sensation to the face and helps control some jaw movement.

Pain attacks are often brief but intense, sometimes described as “electric shocks”, “stabbing”, or “shooting” pain. Symptoms can come in clusters over days or weeks and may then settle for a period.

At the Royal Buckinghamshire Hospital, we provide consultant-led assessment to confirm the diagnosis, rule out other causes of facial pain, and develop a treatment plan aimed at reducing attacks and improving quality of life.

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Types of Trigeminal Neuralgia

Trigeminal neuralgia is often grouped into:

• Classical trigeminal neuralgia
  Usually caused by a blood vessel pressing on the trigeminal nerve near where it enters the brainstem.
• Secondary trigeminal neuralgia
  Caused by an underlying condition affecting the nerve, such as multiple sclerosis, a tumour, or structural changes (less common).
• Idiopathic trigeminal neuralgia
  No clear cause is found after investigation.

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Common Causes of Trigeminal Neuralgia

The most common underlying mechanism is compression of the trigeminal nerve by a nearby blood vessel. This pressure can irritate the nerve and lead to abnormal pain signalling.

Less common causes include:

• Multiple sclerosis or other neurological disease
• Structural causes such as tumours or cysts affecting the nerve
• Previous facial trauma or surgery (in selected cases)

Because treatment may differ depending on the cause, accurate diagnosis is important.

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Symptoms of Trigeminal Neuralgia

Typical symptoms include:

• Sudden bursts of severe facial pain, usually on one side
• Pain often described as electric shock-like, stabbing, or shooting
• Attacks that last from seconds to a couple of minutes
• Multiple attacks in a day (some people have frequent clusters)
• Pain most commonly affects the cheek, jaw, teeth, gums, lips, or around the eye
• Pain can be triggered by everyday activities, such as:
  • Touching the face (even lightly)
  • Brushing teeth
  • Shaving or applying makeup
  • Eating, chewing or talking
  • Cold wind or air conditioning

Between attacks, some people are pain-free, while others may have a dull ache or sensitivity.

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Diagnosis at Royal Buckinghamshire Hospital

Diagnosis is based on your symptom pattern and a neurological assessment. Your consultant may:

• Ask about pain location, triggers, frequency and duration
• Assess sensation and facial nerve function
• Review dental history (to rule out tooth-related pain)
• Recommend imaging (commonly MRI scan) to:
  • Look for nerve compression by a blood vessel
  • Rule out secondary causes (such as multiple sclerosis or other structural issues)

You will receive a clear explanation of the likely diagnosis and recommended next steps.

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Treatment & Management

Treatment aims to reduce frequency and severity of pain attacks, and improve daily function. Management is tailored to your symptoms, triggers, general health and preferences.

Medication

Trigeminal neuralgia is usually treated with medicines that stabilise nerve signalling. Your consultant will discuss options, start treatment carefully, and monitor effectiveness and side effects. Dose adjustments are often needed to find the best balance.

Standard painkillers often do not control trigeminal neuralgia well on their own.

Practical trigger management

You may also be advised on:

• Identifying triggers and minimising flare-up patterns
• Adjusting oral hygiene routines during flare-ups (without compromising dental health)
• Maintaining nutrition if eating becomes difficult during severe episodes

Specialist referral pathways and procedures (when needed)

If pain remains severe despite medication, or side effects limit treatment, your consultant may recommend referral to a specialist team to discuss procedural options. Depending on your diagnosis and scan findings, options may include:

• Procedures targeting the trigeminal nerve to reduce pain signalling
• Microvascular decompression in selected cases where vascular compression is confirmed

Your consultant will explain benefits, risks and suitability based on your specific presentation.

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When to seek urgent help

Seek urgent medical advice if you have facial pain with:

• New facial weakness or drooping
• New numbness that is persistent or worsening
• Vision changes
• Severe headache, confusion, or other new neurological symptoms
• Fever or signs of infection

These symptoms are not typical of classic trigeminal neuralgia and need prompt assessment.

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If you are experiencing severe shock-like facial pain triggered by touch, chewing or brushing your teeth, contact Royal Buckinghamshire Hospital for assessment and management planning. There is no need to be registered with the hospital, or live locally.

If you have insurance which covers consultations, we can in most cases invoice the insurer directly. Where you are paying directly, any costs will always be discussed.