Trigeminal Neuralgia

By | June 10, 2022

Trigeminal neuralgia, or facial neuralgia, is disease or overstimulation of the 5th cranial nerve. The symptoms are severe paroxysmal pain in the face. The treatment is initially carried out with medication, in severe cases an operation may be necessary.

What is trigeminal neuralgia?

Trigeminal neuralgia is a disease of the trigeminal nerve. With its three branches (trigeminus = triplet), it innervates the face, the chewing apparatus and the pharynx and is directly connected to the brain. It is one of the 12 cranial nerves and is known as the 5th cranial nerve. For hemolysis definition and meaning, please visit

Neuralgia is the medical term for nerve pain (neuron = nerve, -algia = pain). Trigeminal neuralgia manifests itself in attacks of pain in the cheek, upper and lower jaw, and on the forehead, around the eye, or in the frontal sinus.

A distinction is made between symptomatic and classic trigeminal neuralgia. The less common symptomatic form occurs as an accompaniment to other underlying diseases, often in multiple sclerosis or after a stroke. It often occurs on both sides. Classic trigeminal neuralgia is the more common type. It usually only develops on one side and is characterized by symptom-free intervals.


Trigeminal neuralgia is caused by damage, overstimulation, or disease of the 5th cranial nerve (trigeminal nerve). In classic trigeminal neuralgia, the trigger is usually increased pressure on the nerve.

This is caused by thickened blood vessels. When arteries become hardened, they lose their elasticity and become thick and immobile. If such a thickened artery is close to the nerve, it creates pressure and thus causes irritation or damage to the nerve.

In the rarer symptomatic trigeminal neuralgia, the cause lies in another disease. In multiple sclerosis, the nerves become inflamed, triggering trigeminal neuralgia, and in the case of a stroke, a circulatory disorder in the brain can cause neuralgia.

Symptoms, Ailments & Signs

The main symptom of trigeminal neuralgia is a sharp, unilateral facial pain that comes on suddenly and sharply. It almost feels like a lightning surge of electricity that dies down again after a short time. Sometimes the pain is also perceived as burning or stabbing. Depending on which branch of the trigeminal nerve is affected, the symptoms are in the corresponding area of ​​the face.

The second and third branches are most often affected. This leads to pain in the cheeks, cheekbones and chin, nose or upper and lower jaw. Teeth can hurt too. On the other hand, complaints on the forehead, where the first nerve branch runs, are rather rare. The pain attacks can be triggered by touching the skin, by a draft, by brushing your teeth, by movements of the jaw when speaking or chewing, or by swallowing.

However, they can also flare up completely suddenly and without a previous stimulus. Sometimes the shooting pain is accompanied by twitching of the facial muscles. The trigeminal nerve is one of the thickest nerves in the body, so the pain it causes is almost unbearable.

Fearing an attack of pain, some patients refrain from eating and drinking. This can cause weight loss and dehydration. Since the symptoms are extremely distressing, the disease can lead to depression.

Diagnosis & History

The main symptoms of trigeminal neuralgia are sudden, severe pain in the face that lasts only a few seconds and then subsides. They feel like electric shocks and can repeat themselves in several short intervals and then disappear for a period of time.

These pain attacks are often triggered by touching the face or by movements of the jaw. It can happen when chewing or swallowing, brushing your teeth or even when speaking. Sometimes the attacks are also triggered by a draft. Trigeminal neuralgia pain is some of the most severe pain there is. Affected people often avoid eating or speaking, as this triggers the pain attacks.

In order to be able to make a definite diagnosis of trigeminal neuralgia, the doctor must first ask about the medical history of the patient and examine him neurologically. A dental, orthopedic and ENT examination can rule out other diseases with similar pain. Magnetic resonance imaging ( MRI ) can be used to detect previous strokes, tumors or inflammation that may be the trigger for trigeminal neuralgia.


The extremely painful trigeminal neuralgia can have various complications. These are usually classified as postoperative complications. Due to the paroxysmal and severe pain, those affected by trigeminal neuralgia can suffer from pain-related depression.

Apart from the medical treatment goal of achieving permanent pain relief, psychotherapeutic interventions are sometimes necessary. If the pain attacks of trigeminal neuralgia cannot be alleviated with medication – or if they have too strong side effects – surgical methods are common. The previous cutting of the trigeminus usually led to partial facial paralysis.

Since this surgical method often caused more pain than before, this treatment method has been abandoned. But even the surgical methods used today are not without risk. In the case of symptomatic trigeminal neuralgia, the potential complications can be influenced by the underlying disease.

It can be cancer or multiple sclerosis. Corresponding complications such as metastasis formation, paralysis or blindness are conceivable. After operations on the Ganglion Gasseri, pressure sensitivity, sensory disturbances or even more severe pain can occur. However, these are usually permanent pains.

In microvascular decompression, there is an increased risk of anesthesia as well as a higher risk of complications. Occasionally, the procedure leads to unilateral hearing loss, bleeding or cerebellar swelling. Comparatively fewer complications occur when the irritated trigeminal nerve is irradiated with a linear accelerator. The success rate is significantly lower.

When should you go to the doctor?

Since trigeminal neuralgia is accompanied by massive facial pain, the person concerned should see a doctor as soon as possible. This must determine whether there was a specific trigger, or whether it is an idiopathic trigeminal neuralgia.

In the symptomatic variant of trigeminal neuralgia, the triggering basic problem must be determined as soon as possible. Only then can targeted treatment begin. In the course of this, the massive facial pain can also disappear.

A quick visit to the doctor is also advisable because the severe pain symptoms in the facial area can hide a late complication of shingles, a tumor or multiple sclerosis. Stroke symptoms or Lyme disease have also been identified as triggers for symptomatic trigeminal neuralgia. Tumors are rarely the trigger of trigeminal neuralgia. If they are, however, the tumors can be both benign and metastatic extensions of an as yet undetected tumor.

All in all, the possible triggers are serious enough not to endure trigeminal neuralgia for months on self-prescribed painkillers. That being said, the pain associated with trigeminal neuralgia is often severe. So going to the doctor often happens on its own.

Treatment & Therapy

Trigeminal neuralgia is initially treated with painkillers. However, the usual pharmacy-only medications are ineffective here, as the pain is extremely severe. If a large number of pain attacks occur one after the other in a short period of time, treatment is given intravenously with a high-dose antiepileptic drug.

For this therapy in the case of an acute attack, inpatient admission to a hospital is necessary. To prevent the pain attacks, antiepileptic drugs are given as tablets in lower doses but permanently. If there are other underlying diseases, they must be treated first and foremost, as they are the triggers for trigeminal neuralgia.

If the drug treatment does not improve, an operation is possible. The skull bone is opened in a surgical procedure in order to free the nerve from constricting vessels. Another treatment option that does not require surgical opening of the skull is radiosurgical therapy. The nerve is treated with radiation through the bone.

A third option for treating trigeminal neuralgia is percutaneous (through the skin) thermoagulation, in which a probe is pushed to nerve cells of the trigeminal nerve under short-term anesthesia and the pain fibers of the nerve are destroyed there with heat.


There is no prevention against trigeminal neuralgia. However, a balanced diet and a healthy lifestyle can prevent hardening of the arteries, which is often the cause of trigeminal neuralgia.


If trigeminal neuralgia is treated with surgery, follow-up care is required. In most cases, the symptoms improve immediately after the operation. A computer tomography (CT) scan is usually carried out on the day of the operation. This allows the doctor to diagnose possible air pockets or postoperative bleeding.

The patient spends the first five to six days after the operation in the hospital. After that, he is usually released. Outpatient care is usually sufficient to remove sutures or staples. Restrictions are usually not to be feared after the hospital stay. Health impairments no longer exist in most patients after discharge.

The painkillers that the patient has been taking up to now should be gradually reduced in consultation with a neurologist or pain therapist. The therapist provides supportive care. In rare cases, symptoms in the scar area, headaches, fever or discharge of a clear liquid from the nose occur after the operation. In this case, the person concerned must consult a neurosurgeon. Rehabilitation does not need to be started.

It usually takes about three to four weeks before the patient can resume physical activity. During this period, stays in the sauna or in the blazing sun should also be avoided, as otherwise dizziness or headaches may occur.

You can do that yourself

The possible self-help measures for trigeminal neuralgia are limited. They relate to support for medical treatment and are of a general nature.

Avoiding stress and eating a balanced diet contribute to well-being. Some patients rely on autogenic training or other relaxation techniques. Others have stepped back professionally and integrated rituals that allow time out into their day. Regular exercise is also considered an important factor in alleviating renewed pain attacks. The consumption of nicotine and alcohol should be stopped completely. These measures do not necessarily prevent all complaints. However, due to an increased sense of well-being, they do not make the symptoms appear so troublesome.

The everyday life of those affected is severely affected because the attacks can recur. Some patients suffer from chronic anxiety. This often results in a withdrawn life without activities. As a result, depression often sets in. Escaping this state can be difficult. A strong environment and social contacts promise a positive approach to trigeminal neuralgia. Sometimes contact with like-minded people helps too. In self-help groups, experiences and tips for coping with everyday life can be exchanged.

Trigeminal Neuralgia