Trigeminal neuralgia, usually shortened to TN, is a long-term pain condition affecting the trigeminal nerve, which carries sensation from the face to the brain.
TN is classified as classical, secondary or idiopathic. Classical TN is associated with a blood vessel compressing the nerve and causing changes to it. Secondary TN is caused by another condition, such as multiple sclerosis or, less commonly, a tumour. Idiopathic TN is used when no clear cause is found after appropriate assessment.
Some people have only brief attacks. Others also experience a more continuous aching or burning pain between attacks.
There is no single test that proves TN. Diagnosis is based mainly on the description and pattern of pain, together with clinical examination and the exclusion of other causes.
Because pain may be felt in the teeth or jaw, many people first see a dentist. Dental causes should be assessed, but irreversible dental treatment should not continue when no dental cause has been found.
A GP may refer someone to neurology or a specialist facial pain service. Neurosurgical assessment may be considered when a procedure is being discussed. MRI is often used to look for possible causes, including multiple sclerosis, a tumour or clinically relevant neurovascular compression.
A doctor will usually offer carbamazepine as the initial medicine for trigeminal neuralgia. It must be prescribed and monitored by a clinician.
If carbamazepine is unsuitable, ineffective or poorly tolerated, specialist advice is normally needed. Other medicines may be considered off-label after discussion of benefits, risks and monitoring.
When medicines do not provide adequate control or cause unacceptable side effects, a specialist may discuss procedures. These include microvascular decompression, percutaneous procedures and stereotactic radiosurgery. Each has different potential benefits, limitations and risks.
Fear of triggering pain can affect eating, drinking, speaking, washing, dental care and social contact. A pain record can help show attack length, frequency, triggers, background pain and the effect of treatment.
Tell the prescribing clinician about dizziness, unsteadiness, severe drowsiness, skin reactions or other worrying effects. Do not stop anticonvulsant medication suddenly unless a clinician advises it.
Fear of triggering another TN attack can affect eating, speaking, face care, sleep, confidence and social contact.
Support for sleep, anxiety, low mood and coping can sit alongside medical treatment. It does not mean the pain is imagined.
If you feel unable to keep yourself safe, call 999 or go to A&E. For urgent mental-health help that is not an immediate emergency, use NHS 111 and select the mental-health option where available.
It can, but it is uncommon and usually does not affect both sides at the same time. Bilateral or changing symptoms should be assessed.
No. MRI can identify possible causes, but scan findings must be interpreted with the pain history and examination.
Paracetamol and ibuprofen are usually not effective for TN attacks. Treatment commonly uses medicines that reduce abnormal nerve signalling.
No. Suitability depends on the diagnosis, imaging, health, previous treatment and the balance of benefits and risks.
Other facial pain conditions and useful information
This information is for general guidance and does not replace professional medical advice. Always consult your healthcare professional.
What 567 people affected by trigeminal neuralgia and facial pain told TNA UK Pain is usually recorded at the point of care. Much of its impact happens somewhere else: at […]
