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Learn about trigeminal neuralgia symptoms, diagnosis, and treatment.

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Facial Pain and Trigeminal Neuralgia

Western Massachusetts’ Leader in Treating Facial Pain

If you have facial pain or trigeminal neuralgia, we understand the pain and challenges you face. You don’t have to live with this pain, and you don’t have to deal with it alone.

The specialized neurologists and neurosurgeons at Baystate Health are here to help you find relief. We are the only healthcare system in western Massachusetts that treats trigeminal neuralgia, and we treat more patients for it than some of the state’s largest medical institutions. Patients come from across the country and throughout the world to access our expert care for this painful condition.

What Is Trigeminal Neuralgia?

Trigeminal neuralgia, sometimes called tic douloureux, is a chronic (long-lasting) condition that affects the trigeminal nerve. You have two trigeminal nerves — one on each side of your face. These nerves transmit pain and other sensations from your face to your brain. Most people with trigeminal neuralgia only have one nerve affected by the condition.

The trigeminal nerve has three branches: ophthalmic, maxillary and mandibular. The location of your trigeminal neuralgia pain depends on what part of the trigeminal nerve is affected. Most people feel it in the lower part of their face. 

Trigeminal Neuralgia Symptoms

Severe, recurring facial pain is the main symptom of trigeminal neuralgia. This pain may include sensations of stabbing or electrical shock in the cheek or jaw. Some people mistake the pain as a result of a dental condition and have teeth removed to try to find relief.

Your pain may last a few seconds to a few minutes at a time. Most people have periods of weeks, months, or longer without pain, followed by episodes of several pain attacks over a long period. Unfortunately, trigeminal neuralgia can progress and cause worsening pain that lasts longer.

What Causes Trigeminal Neuralgia?

The main cause of trigeminal neuralgia is a blood vessel pressing against the trigeminal nerve. Trigeminal neuralgia can also develop due to multiple sclerosis (MS), because MS can damage the nerve’s myelin sheath (a protective coating). In some cases, trigeminal neuralgia can be the result of a brain tumor.

You may notice that pain attacks from trigeminal neuralgia occur after certain trigger behaviors, such as:

  • Being touched on the face
  • Eating
  • Feeling a light breeze on the face
  • Talking
  • Washing your face

Some patients may avoid eating, talking, and other trigger behaviors to try to avoid the pain.

Most people with trigeminal neuralgia are over 50. However, you can develop the condition at any age. You’re more likely to have trigeminal neuralgia at a younger age if you’ve been diagnosed with MS. Women are also more likely to develop this condition than men.

How We Diagnose Trigeminal Neuralgia

Your doctor will ask you a series of questions and ask you to describe your pain. Based on the type of pain you experience, where the pain is located, and what actions or behaviors trigger your pain, we’ll determine whether you may have trigeminal neuralgia.

Next, we’ll prescribe a medication called carbamazepine (Tegretol or Carbatrol), which is commonly used to treat seizures. If this medication relieves your pain, you likely have trigeminal neuralgia.

If your doctor diagnoses you with trigeminal neuralgia, you’ll need a magnetic resonance imaging (MRI) exam. This is to make sure your trigeminal neuralgia isn’t the result of MS or a brain tumor, both of which can affect your treatment plan.

How We Treat Trigeminal Neuralgia

Our expert neurology and neurosurgery team will discuss your treatment options and help you decide which is best for you.

Trigeminal Neuralgia Medicines

Many people manage this condition for long periods of time with medication. Your neurologist can help you find the best treatment.

Trigeminal Neuralgia Surgery

If medication no longer works to control your facial pain, there are surgical options available including Microvascular Decompression (also known as the Jannetta procedure) and Glycerol Rhizotomy.  Learn more about our neurosurgical treatments for trigeminal neuralgia.

Are Your Symptoms Trigeminal Neuralgia?

If you have facial pain but you're not sure if you have trigeminal neuralgia, take our online risk assessment to learn more. We'll ask you a series of questions. After you answer all the questions, you will receive recommended next steps based on your answers.

Take the Risk Assessment

If your answers suggest that you might have trigeminal neuralgia, our neurology team will guide you through next steps including the advanced treatment options available at Baystate Health. Learn about those treatment options below, and call us if you have questions: 413-794-5600.

Common Questions About Trigeminal Neuralgia

What is the main cause of trigeminal neuralgia?

Usually trigeminal neuralgia is caused by a blood vessel pressing against the trigeminal nerve at the brain stem (this is called vascular compression). Sometimes TN can also be caused by:

  • Dental procedures
  • Facial trauma
  • MS (multiple sclerosis)
  • Tumors (rare)

What does trigeminal neuralgia pain feel like?

Trigeminal neuralgia pain has been described as the worst pain known to humanity. Patients describe the pain as a "lightning bold through the face" and usually remember exactly when they first experienced TN pain. TN can be triggered by talking, eating, and brushing teeth.

What is the most common treatment for trigeminal neuralgia?

Many people with TN are misdiagnosed and end up having unnecessary dental procedures (including teeth removal) before eventually learning they have TN.

Once a patient is diagnosed with TN by a neurologist, they may be prescribed medicine (Tegretol, or carbamazepine, is considered the standard). Medicine helps the pain but does not cure TN. It can be difficult to be on this type of medicine long term, so the condition may worsen over time.

If medicine is no longer working for your pain, there are surgical options including Microvascular Decompression and Glycerol Rhizotomy. Learn more about surgical trigeminal neuralgia treatment options. 

Can trigeminal neuralgia be cured?

Yes, under certain circumstances trigeminal neuralgia can be cured. If your TN is the result of a blood vessel making contact with the trigeminal nerve in the face, you may be a good candidate for microvascular decompression (MVD). MVD provides relief for about 80% of patients.

Are there foods that trigger trigeminal neuralgia?

Your doctor will recommend paying attention to triggers that affect you, including foods. You do not need to avoid specific foods if they don't trigger attacks. However, maintaining a healthy, nutrient-rich diet is always important.

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