Imagine a sharp, electric shock jolting across one side of your face, triggered by something as simple as brushing your teeth or applying makeup. This is trigeminal neuralgia, a chronic condition that affects the trigeminal nerve, which carries sensation from the face to the brain.

The condition often begins with brief, mild bursts of pain, but over time, these episodes can become longer, more frequent, and more intense. Trigeminal neuralgia, also known as tic douloureux, is more common in women and people over 50, and it can significantly disrupt daily life.

Trigeminal neuralgia (TN) usually occurs when a blood vessel presses on the trigeminal nerve near the brainstem. Because this nerve transmits sensory information from the face and head, the pressure leads to neuropathic pain, a type of pain caused by nerve dysfunction.

Despite its severity, living with trigeminal neuralgia doesn’t have to mean constant suffering. With proper treatment, most people can manage the pain and regain control of their everyday activities.

Causes and Risk Factors

Trigeminal neuralgia generally occurs when the trigeminal nerve is compressed or damaged. Doctors classify TN according to its underlying cause:

• Primary (classic) TN: This form arises when a blood vessel, often the superior cerebellar artery, presses against the trigeminal nerve root. Nerve compression of this type is the most common cause of TN.

• Secondary TN: This type develops when another condition harms the trigeminal nerve, such as multiple sclerosis (MS), a tumor, or an arteriovenous malformation. Secondary TN is more likely to occur in younger individuals and can affect both sides of the face. Only about 15% of TN cases fall into this category.

• Idiopathic TN: In idiopathic TN, no definite cause for the facial pain can be found even after diagnostic tests.

Certain factors can increase a person’s risk of developing trigeminal neuralgia. These include high blood pressure, a history of smoking, and aging. Women are more commonly affected than men, and having a close family member with TN can also raise the likelihood of experiencing this condition.

Symptoms and Triggers

The hallmark of trigeminal neuralgia is sudden, intense, sharp facial pain that can last anywhere from a few second to around two minutes. Many describe the sensation as excruciating, similar to an electric shock, and the pain can be so severe that it temporarily prevents any activity.

TN usually affects only one side of the face, though in rare cases both sides may be involved at different times. The pain often occurs in the teeth, lower or upper jaw, or cheek, and less commonly in the forehead or eye. After the most intense episodes, some people may feel a lingering ache, burning, or throbbing sensation between attacks.

Pain episodes can come in clusters lasting days, weeks, or months, followed by periods of remission that may last several months or even years. In severe cases, attacks may occur hundreds of times in a single day with little or no relief in between.

Episodes of trigeminal neuralgia can often be set off by everyday activities or movements. Common triggers include talking, smiling, chewing, brushing teeth, washing the face, or even a light touch. Shaving, applying makeup, swallowing, exposure to a cool breeze or air conditioning, head movements, and vibrations from walking or traveling in a car can also provoke pain. However, it’s important to note that in many cases, attacks can occur spontaneously without any identifiable trigger.

Diagnosis

Diagnosing trigeminal neuralgia can be difficult because there are no specific tests and its symptoms often resemble other facial pain disorders. If you feel sudden, sharp pain around the eyes, lips, nose, jaw, forehead, or scalp, especially without recent dental or facial surgery, it is important to see a doctor. Patients usually start with a primary care physician, who may refer them to a specialist.

MRI scans can help detect tumors, multiple sclerosis, or blood vessel compression affecting the trigeminal nerve, though vein-related compression is harder to see. Imaging also helps rule out other causes of facial pain.

Diagnosis mainly depends on the patient’s description of symptoms, medical history, and clinical evaluation. Doctors look at the type, location, and triggers of the pain and may perform a physical and neurological exam by gently examining the face.

Treatment

Trigeminal neuralgia is usually treated first with medication. Anticonvulsants such as carbamazepine, oxcarbazepine, and gabapentin help block pain signals. Other options like baclofen or Botulinum toxin A may be used if needed, while common painkillers and opioids are usually ineffective.

If medication fails or side effects are severe, surgery may be considered. Options include microvascular decompression to relieve nerve pressure, rhizotomy to block pain (which can cause numbness), and radiosurgery, which uses targeted radiation for gradual pain relief. Surgery carries risks and may require hospitalization depending on the procedure.

Some people also benefit from complementary therapies alongside medication, such as yoga, meditation, low-impact exercise, acupuncture, or nutritional support.

Lifestyle and self-care tips

Taking an active role in your overall wellness can help you feel empowered and improve your quality of life. While lifestyle changes may not eliminate facial pain, focusing on healthy habits like good sleep, balanced nutrition, proper oral care, and regular physical activity can make a significant difference in how you feel day to day.

Sleep is essential for both brain and body health, and it plays an important role in managing facial pain. Improving your sleep quality is a worthwhile investment. Helpful approaches include:

• Cognitive Behavioral Therapy (CBT): Helps identify and reframe unhelpful thoughts about sleep, while teaching relaxation strategies and ways to improve your sleep environment.

• Relaxation techniques: Practices such as deep breathing, meditation, or guided imagery can calm the mind and body before bedtime.

• Healthy sleep habits: Go to bed at the same time each night, avoid electronics before sleep, limit daytime naps, keep your bedroom calm and comfortable, avoid late dinners, and exercise regularly.

• Listening to your body: Cold hands or feet can signal reduced blood flow from pain, showing your body may not be ready for rest yet.

• Staying active: Regular exercise or physical activity helps your body feel naturally tired at bedtime.

Takeaway

Trigeminal neuralgia is a chronic but manageable condition. Though the pain can be sudden, severe, and life-disrupting, understanding its causes, recognizing triggers, and seeking timely medical care are key to relief. Diagnosis relies largely on symptom history and imaging to rule out other conditions. Treatment often begins with anticonvulsant medications, with surgical or complementary options available if needed. Alongside medical care, healthy lifestyle habits such as quality sleep, balanced nutrition, regular activity, and stress management can help improve overall well-being. With proper treatment and self-care, many people are able to regain control of their daily lives despite TN.

References

1. Mayo Clinic. Trigeminal neuralgia - Symptoms and causes. Updated December 28, 2023. Accessed September 23, 2025. https://www.mayoclinic.org/diseases-conditions/trigeminal-neuralgia/symptoms-causes/syc-20353344

2. Cleveland Clinic. Trigeminal neuralgia: What it is, causes, symptoms, and treatment. Accessed September 23, 2025. https://my.clevelandclinic.org/health/diseases/15671-trigeminal-neuralgia-tn

3. National Health Service (NHS). Trigeminal neuralgia - Symptoms. Accessed September 23, 2025. https://www.nhs.uk/conditions/trigeminal-neuralgia/symptoms/

4. National Institute of Neurological Disorders and Stroke (NINDS). Trigeminal neuralgia. Updated March 25, 2025. Accessed September 23, 2025. https://www.ninds.nih.gov/health-information/disorders/trigeminal-neuralgia

5. American Association of Neurological Surgeons (AANS). Trigeminal neuralgia. Published April 10, 2024. Accessed September 23, 2025. https://www.aans.org/patients/conditions-treatments/trigeminal-neuralgia/

6. StatPearls Publishing. Trigeminal neuralgia. Updated 2024. Accessed September 23, 2025. https://www.ncbi.nlm.nih.gov/books/NBK554486/