Like an electric shock
Sharp, shooting pain in the cheek, upper or lower jaw, teeth or gums; less often - in the forehead or near the eye.
CONDITION / FACE
Trigeminal neuralgia.
Trigeminal neuralgia — sudden short attacks of severe pain in half of the face, similar to an electric shock. Treatment begins with drugs, and if they do not help, the neurosurgeon may suggest surgery.
CONCEPTUAL VISUALIZATION- What it is
- Short attacks of sharp pain in half of the face — from a few seconds to about 2 minutes.
- How common
- Rare: in a German population study (3,336 people) — 0.3% at least once in a lifetime.
- The first step
- Medicines — carbamazepine or oxcarbazepine; ordinary painkillers do not work.
- Who treats it
- Neurologist; if drugs do not help - a neurosurgeon.
01 / WHAT IS ITWhat is
What is
trigeminal neuralgia.
The trigeminal nerve transmits touch and pain from the face, teeth and mouth to the brain. In neuralgia, it suddenly sends a signal of severe pain: the attack lasts from a few seconds to about 2 minutes and passes as suddenly as it began. Usually one half of the face hurts, more often the lower part.
Doctors distinguish three forms. Classic — when the nerve inside the skull is pressed by a vessel. Secondary — when the nerve is damaged by another disease, such as multiple sclerosis or a tumor. Idiopathic - when the cause is not found.
This is usually a long-term condition. Attacks may subside for months or years, but over time these lulls become shorter. Pain has a strong impact on life: a person avoids eating, washing, and meeting people in order not to provoke an attack, so the guidelines recommend, in addition to treatment, psychological support.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
neuralgia presents.
There is no separate analysis for neuralgia: the diagnosis is made primarily by how a person describes the pain. This is what is usually described:
From touch
An attack is provoked by talking, smiling, chewing, brushing teeth, washing, shaving, a light touch, a draft or an air conditioner. It happens for no reason.
One side
Usually one half of the face is affected. In a study of 158 patients, pain was only in the area of the middle and/or lower branch of the nerve — cheek and jaw — in 69%.
Pain between attacks
Aching, throbbing or burning background may remain. In the same study, 49% had such constant pain, in addition to attacks.
Series of attacks
Attacks last for days, weeks or months. In severe cases - hundreds of times a day and without periods of calm.
"Toothache"
Pain is often felt in the teeth, so many people first go to the dentist, and the diagnosis is sometimes established only after several years.
03 / REASONSWhy does it occur?
Why does it occur?
neuralgia
Which treatment is suitable depends on the cause, so it must be clarified.
A vessel near a nerve
Usually, the nerve inside the skull is pressed by a nearby vessel. But visible changes in the nerve at the point of compression are found only in half of the patients with the classic form.
Multiple sclerosis
Can damage the nerve and cause secondary neuralgia. However, neuralgia is very rarely the first manifestation of multiple sclerosis.
A tumor
A growth near the nerve can also cause pain. Therefore, MRI is recommended for everyone, even when the symptoms are typical.
Age and gender
Women and older people get sick more often; usually begins in 50-60 years, rarely before 40. In the study of 158 patients, 60% were women, and the average age at onset was 52.9 years.
Similar pains
Pain from a tooth or jaw, cluster headache, pain after shingles — they are ruled out before making a diagnosis.
Temporomandibular joint dysfunction
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Neuralgia itself usually does not require emergency care, but you do not need to endure pain: if the attacks are repeated, consult a doctor. Call 103 if you have signs of a stroke or a severe reaction to medication.
103 immediately if:
- the face was suddenly crooked - the corner of the mouth dropped, it was difficult to smile;
- a person cannot raise both hands and hold them;
- speech suddenly became slurred or confused;
- sudden weakness or numbness on one side of the body;
- sudden deterioration or loss of vision in one or both eyes;
- sudden confusion of consciousness;
- sudden very severe headache;
- signs of a stroke appeared and disappeared - call 103 in the same way;
- on the background of carbamazepine - a severe rash with redness, blisters or ulcers;
- against the background of the medication, the throat or tongue swelled or it became difficult to breathe;
- thoughts of harming oneself or ending one's life appeared.
Do not delay a visit to the doctor:
On the same day, to the doctor who prescribed the medicine: against the background of carbamazepine, the skin or the whites of the eyes turned yellow; you became pregnant while taking carbamazepine. In the coming days - to the family doctor or neurologist: attacks of pain in the face are repeated, ordinary painkillers do not help, and the dentist did not find the cause in the teeth; the pain is combined with numbness of the part of the face that has grown gradually, or hurts on both sides - this is a reason to look for a secondary cause; drugs have stopped working or side effects interfere with life. Do not stop the medicine suddenly and do not increase the dose yourself. Planned: if the drugs do not control the pain or are poorly tolerated, consult a neurosurgeon about surgery.
05 / DIAGNOSTICSHow we make the
How we make the
diagnosis
- Conversation
How often and how long the attacks last, where they hurt, what provokes them, what medicines have already been taken.
- Review
Face, jaw and skin sensitivity. Numbness or pain on both sides is a reason to look for a secondary form.
- Examination of the dentist
To rule out the cause in the teeth: an infection or a cracked tooth. If the dentist did not find the cause, go to the neurologist.
- MRI
MRI of the brain with special modes of instruction is advised to everyone: no sign allows to exclude the secondary form without it. It shows whether the vessel touches the nerve and whether there is multiple sclerosis or a tumor.
06 / TREATMENTHow we treat
How we treat
neuralgia
Treatment begins with medication - that's what the guidelines advise. Surgery is offered if medications do not adequately control pain or are poorly tolerated. Medicines are selected by a neurologist, operations are performed by a neurosurgeon.
01
Medicines
The first step for everyone.
- Carbamazepine
- An anticonvulsant is the drug of first choice; an alternative is oxcarbazepine. In a study of 354 patients, 88.3% responded to carbamazepine and 90.9% to oxcarbazepine at the beginning of treatment.
- How to take
- Every day, not just during an attack. The dose is increased gradually, and during a lull it is reduced slowly, over several weeks. Over time, the drug may become less effective.
- Side effects
- Drowsiness, dizziness, unsteadiness, double vision. In the same study, side effects occurred in 43.6% of patients on carbamazepine and in 30.3% on oxcarbazepine; 29.6% on carbamazepine had to stop treatment or reduce the dose to insufficient because of them.
- Warning
- Carbamazepine interacts with other medications, including hormonal contraception; during pregnancy or its planning, it is prescribed only after weighing the risks. Grapefruit and its juice are not used during treatment.
- Other drugs
- Lamotrigine, gabapentin, pregabalin, baclofen, botulinum toxin — separately or additionally; they are selected by a neurologist. In case of a sharp exacerbation, drugs can be administered intravenously in the hospital.
02
Operations
If medicines do not help or are poorly tolerated.
- Microvascular decompression
- The neurosurgeon, under anesthesia, diverts the vessel from the nerve through a small opening in the skull without damaging it. The instructions call it the first operation in the classical form. In a review of 46 studies (3,897 patients), 76% were pain free after an average of 1.7 years; in a cohort of 1,185 patients, after 10 years, 70% did not have pain and did not need medication.
- Risks of decompression
- This is a major operation. In the same cohort of 1,185 patients, two died after surgery (0.2%), brainstem stroke occurred in one (0.1%), and hearing on the side of surgery decreased in 1%. During the follow-up period (median — 6.2 years), pain returned in 30%.
- Percutaneous procedures
- A needle or a thin tube is passed through the cheek to the nerve node and the pain fibers are deliberately damaged - with heat, glycerol or a balloon. Home - the same or the next day. Relief usually lasts for several years or months; the main side effect is numbness of part of the face, which can be permanent.
- Radiosurgery
- Focused irradiation of the nerve without incisions and anesthesia; the effect comes in weeks or months. In a review of 65 studies (6,461 patients), after the gamma knife, pain initially disappeared without medication in an average of 53.1% (almost all studies were retrospective), facial numbness - in an average of 21.7%, and pain returned in an average of 24.6%.
03
How to choose
- Form and MRI
- If the MRI shows a vessel impinging on the nerve, this helps decide whether decompression is appropriate; if there is no vessel, the guidelines recommend giving priority to procedures that damage the nerve.
- The evidence
- Comparative studies are few: a Cochrane review (11 studies, 496 participants) rated the evidence for most operations as very low quality. No method works for everyone, and after each one the pain may return.
- support
- Prolonged pain is exhausting. The guidelines recommend psychological support; it's important to eat and drink enough—exhaustion and dehydration can make pain worse.
07 / AT THE VALIKHNOVSKYI INSTITUTE
What
What
we will help
At Dr. Valikhnovskyi's Institute of Surgery, conditions of the face and jaws lead in the direction of "New face". The clinic does not treat trigeminal neuralgia itself: drugs are prescribed and monitored by a neurologist, nerve operations — decompression, percutaneous procedures, radiosurgery — are performed by a neurosurgeon. At the consultation, the doctor will help to deal with the pain in the face and the next steps.
CLINIC SERVICE
A new face
Form, symmetry, facial expressions and functions after injuries, wounds, burns, removal of tumors and congenital changes.
View service
What we do for this condition
- Consultation and assessment — the doctor finds out the clinical situation: how and where it hurts, what examinations and treatments have already been done.
- Preliminary assessment based on documents — if you are not in Kyiv, send pictures, extracts and a description of the attacks.
- Next steps — the doctor will explain which examinations are missing and which specialist to contact next - a neurologist or a neurosurgeon.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How does the consultation work?
- Documents onlineSend the discharges, MRI, if any, and describe the attacks: where it hurts, how long it lasts, what provokes it.
- ConsultationExamination of the face and jaws, analysis of previous examinations and treatment.
- PlanWhat examinations are lacking and who should be consulted next - a neurologist or a neurosurgeon.
- TreatmentMedicines are selected by a neurologist; if they do not help, nerve surgery is discussed with a neurosurgeon.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Can trigeminal neuralgia be cured?
It is usually a long-term condition, but treatment helps most. Medicines control pain in many patients; after microvascular decompression in a review of 46 studies, 76% were pain free at an average of 1.7 years. After any method, the pain may return.
Why do not ordinary painkillers help?
Common pain relievers such as paracetamol do not work for this pain. Therefore, anticonvulsant drugs are prescribed - carbamazepine or oxcarbazepine - which are taken daily.
A toothache - maybe it's neuralgia?
Maybe: pain is often felt in the teeth and jaw. In a survey of 117 patients with neuralgia, 65.8% went to the dentist because of pain, and on average 1.6 teeth were removed per person. If the dentist cannot find the cause in the teeth, consult a neurologist before treating or removing the teeth.
Why MRI, if the diagnosis is based on symptoms?
In order not to miss the secondary form — multiple sclerosis or a tumor. No sign allows to exclude it without MRI. MRI also shows whether the vessel is touching the nerve, which helps decide whether decompression is appropriate.
Is it possible to stop the medicine when the pain is gone?
Only on the advice of a doctor. During a lull, the dose is reduced gradually over several weeks: abrupt cessation or too rapid an increase in the dose can be dangerous.
Which operation to choose?
They are chosen together with a neurosurgeon. Microvascular decompression provides the longest relief, but it is a major operation with the skull opened. Percutaneous procedures and radiosurgery do not require opening the skull, but relief is usually shorter and the main side effect is facial numbness.
Is neuralgia treated at the Valikhnovskyi clinic?
No: neuralgia is treated by a neurologist, nerve operations are performed by a neurosurgeon. At the "New Face" consultation, the doctor will help you understand the examinations and tell you who to contact next.
Sources
21 sources · guidelines, systematic reviews, cohorts and the NHSshowCollapse
- European Academy of Neurology guideline on trigeminal neuralgiaEuropean Journal of Neurology, 2019doi:10.1111/ene.13950 ↗
- AAN-EFNS guidelines on trigeminal neuralgia managementEuropean Journal of Neurology, 2008doi:10.1111/j.1468-1331.2008.02185.x ↗
- Diagnosis and treatment of trigeminal neuralgia: Consensus statement from the Spanish Society of Neurology's Headache Study GroupNeurología (English Edition), 2023doi:10.1016/j.nrleng.2023.04.005 ↗
- Trigeminal neuralgiaNature Reviews Disease Primers, 2024doi:10.1038/s41572-024-00523-z ↗
- Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgiaThe Lancet Neurology, 2020doi:10.1016/S1474-4422(20)30233-7 ↗
- Trigeminal neuralgia – diagnosis and treatmentCephalalgia, 2017doi:10.1177/0333102416687280 ↗
- Neurosurgical interventions for the treatment of classical trigeminal neuralgiaCochrane Database of Systematic Reviews, 2011doi:10.1002/14651858.CD007312.pub2 ↗
- Pain Outcomes Following Microvascular Decompression for Drug-Resistant Trigeminal Neuralgia: A Systematic Review and Meta-AnalysisNeurosurgery, 2020doi:10.1093/neuros/nyz075 ↗
- Stereotactic radiosurgery for trigeminal neuralgia: a systematic reviewJournal of Neurosurgery, 2019doi:10.3171/2017.9.JNS17545 ↗
- Comparative safety and efficacy of percutaneous approaches for the treatment of trigeminal neuralgia: A systematic review and meta-analysisClinical Neurology and Neurosurgery, 2019doi:10.1016/j.clineuro.2019.05.011 ↗
- The Long-Term Outcome of Microvascular Decompression for Trigeminal NeuralgiaNew England Journal of Medicine, 1996doi:10.1056/NEJM199604253341701 ↗
- Real-world effectiveness and tolerability of carbamazepine and oxcarbazepine in 354 patients with trigeminal neuralgiaEuropean Journal of Pain, 2021doi:10.1002/ejp.1727 ↗
- Trigeminal Neuralgia – A Prospective Systematic Study of Clinical Characteristics in 158 PatientsHeadache: The Journal of Head and Face Pain, 2014doi:10.1111/head.12441 ↗
- Prevalence of trigeminal neuralgia and persistent idiopathic facial pain: A population-based studyCephalalgia, 2011doi:10.1177/0333102411424619 ↗
- Please spare my teeth! Dental procedures and trigeminal neuralgiaSurgical Neurology International, 2020doi:10.25259/SNI_729_2020 ↗
- Trigeminal neuralgiaNHS, 2023nhs.uk/conditions/trigeminal-neuralgia ↗
- Trigeminal neuralgia: symptomsNHS, 2023nhs.uk/conditions/trigeminal-neuralgia/symptoms ↗
- Trigeminal neuralgia: diagnosisNHS, 2023nhs.uk/conditions/trigeminal-neuralgia/diagnosis ↗
- Trigeminal neuralgia: treatmentNHS, 2023nhs.uk/conditions/trigeminal-neuralgia/treatment ↗
- Symptoms of a strokeNHS, 2024nhs.uk/conditions/stroke/symptoms ↗
- CarbamazepineNHS, 2026nhs.uk/medicines/carbamazepine ↗
The figures on the page are from these sources.
Attacks of pain
in the face?
Submit statements and describe the attacks. The doctor will tell you what tests are missing and who to contact next.