First Trigeminal Neuralgia Attack

The first trigeminal neuralgia attack: what were you doing when it hit?

I was in a restaurant when my first trigeminal neuralgia attack hit.

One moment I was trying to eat normally. The next, it felt as if I had been struck on the cheek. I screamed. My husband looked at me, then looked again. He said I looked completely normal. Just screaming.

People must have thought I had lost my mind. In the UK we do not “cause a scene”, and yet I could not stop it. The pain felt like a sharp blade slicing through my face. Later I found the word that fit best: lightning.

That was the last time I ate out. Years have passed, but I will never forget that moment, because it was the moment I realised something had changed and nobody else could see it.

The NHS describes trigeminal neuralgia (TN) as sudden attacks of severe, sharp, shooting facial pain that can feel like an electric shock, lasting from a few seconds to about 2 minutes.

If you recognise any of this, you are not alone.

A short clinical

Trigeminal neuralgia is sudden, severe facial pain, often described as a sharp shooting pain or like an electric shock in the jaw, teeth or gums.

Attacks can last from a few seconds up to about 2 minutes and can stop as suddenly as they start.

International diagnostic criteria describe attacks that are severe, electric shock-like, shooting, stabbing or sharp, lasting from a fraction of a second to 2 minutes, often triggered by harmless stimuli in the affected area.

That is the clinical language behind what many patients describe as lightning, knives, live wire, or being hit in the face.

Why the first attack is so frightening

People often use the same words when they describe the first attack.

Jane said: “I thought I was going to die.”
Another person said: “I was convinced it was a brain tumour.”
John said: “It was the worst thing. I thought I’d been attacked.”

Those reactions are not exaggeration. They are a normal human response to pain that arrives fast, peaks hard, and leaves you trying to explain something that has already vanished.

The NHS notes attacks can be so severe you are unable to do anything while they are happening.

Why so many people think of “toothache” first

TN is frequently felt in the jaw, teeth or gums. That is why many people go straight to a dentist first, or assume a cracked tooth, infection, or “sinus”.

It makes sense. The pain sits where dental pain sits.

The problem is that trigeminal neuralgia does not always leave visible clues. When nothing obvious is found, people can start doubting themselves. That is one reason delays happen.

Common triggers: ordinary life, not danger

One of the most unsettling aspects of TN is how often harmless actions can trigger severe pain.

NHS guidance lists triggers such as: talking, smiling, chewing, brushing teeth, washing the face, light touch, swallowing, and even a cool breeze or air conditioning.

That list matters. It gives patients a way to describe what is happening. It also helps clinicians recognise patterns earlier.

If your pain begins with a “small” trigger and causes a “big” reaction, that does not make it less real. It matches recognised descriptions of TN.

How long attacks last and why they confuse people

Attacks can be brief. They can come and go. That makes it hard to describe in a ten-minute appointment.

The NHS states attacks last from a few seconds to about 2 minutes.
ICHD-3 criteria state that pain lasts from a fraction of a second to 2 minutes.

Short, severe, repetitive pain can still dominate your life. It can change how you eat, speak, wash your face, and leave the house.

What to do if this sounds familiar

If you are having recurrent facial pain that fits this pattern, it is reasonable to ask for a proper assessment and appropriate referral. NHS pages set out symptoms, duration, and triggers in plain language.

Treatment decisions are individual, but reputable guidance helps people advocate for themselves. NHS treatment information states carbamazepine is currently the only medicine licensed to treat trigeminal neuralgia in the UK.
NICE Clinical Knowledge Summaries state carbamazepine is the only licensed anticonvulsant medication with proven efficacy to treat trigeminal neuralgia.

Where TNA UK can help

Many people feel isolated because the pain is invisible and unpredictable. Support matters.

If you would like to share your first experience of trigeminal neuralgia, I would really like to hear from you. Please email [email protected] with the subject line: First TN attack.

A few lines are enough. If it helps, use this simple format:

I was ___ when it hit.
It felt like ___.
I thought it was ___.
Next I ___.

If you need support, TNA UK can help you feel less alone and better informed.

If the pain is pushing you into distress

Severe pain can affect sleep, work, relationships and mental health. If you feel unsafe or at risk, seek urgent help.

Call 999 if there is immediate danger.
Samaritans: 116 123, free, 24 hours a day.

One question that people with TN understand instantly

What were you doing when your first trigeminal neuralgia attack hit, and what did you think it was?

If you want to tell your story privately, email [email protected] with the subject line First TN attack.

FAQs

What does trigeminal neuralgia feel like?

The NHS describes sudden attacks of severe, sharp, shooting facial pain, often compared to an electric shock.

How long does a trigeminal neuralgia attack last?

The NHS says from a few seconds to about 2 minutes.
ICHD-3 criteria describe symptoms from a fraction of a second to 2 minutes.

What can trigger trigeminal neuralgia?

NHS guidance lists triggers including chewing, talking, brushing teeth, washing the face, light touch, swallowing, and cold air or air conditioning.

Is there a licensed medicine for trigeminal neuralgia in the UK?

NHS treatment information states carbamazepine is currently the only medicine licensed to treat trigeminal neuralgia in the UK.

References

NHS: Trigeminal neuralgia overview.
NHS: Trigeminal neuralgia symptoms and triggers.
NHS: Trigeminal neuralgia treatment (carbamazepine licensing statement).
NICE CKS: Trigeminal neuralgia management.
ICHD-3: Classical trigeminal neuralgia diagnostic criteria.
Samaritans: 116 123 phone support.

NHS: Trigeminal neuralgia overview (symptoms, causes and treatment).
NHS: Trigeminal neuralgia triggers and symptoms.
NICE CKS: Trigeminal neuralgia (management summary for clinicians).