The main symptom of trigeminal neuralgia is a sudden attack of pain (often described as intense, shooting, stabbing or electrical shock-like) that lasts anywhere from seconds to two minutes. Sometimes the pain hits without warning, while other times even mild stimulation of the face from ordinary activities (such as smiling, brushing teeth, eating, drinking, applying makeup, combing or brushing hair, shaving or touching the skin) can trigger a pain attack. At first the attacks may be short and relatively mild, but over time they last longer, are more painful and happen more often.
The trigeminal nerve has three branches in the face, each of which controls a different part of the face, and any or all branches of the nerve may be affected. The pain typically involves only one side of the face. It can affect the upper, middle or lower portions of the face or all of them. The pain never crosses over to the other side of the face. In rare cases, trigeminal neuralgia is felt on both sides of the face, but the right side pain is separate and distinct from the left side pain.
When experiencing an attack of trigeminal neuralgia, individuals will almost always want to be still and avoid talking or moving the face. The pain may cause the face to contort into a painful wince. Attacks of trigeminal neuralgia rarely occur while sleeping.
During certain periods, the attacks of pain may be worse or more frequent. Individuals may also have extended times with no pain (remission). One of the challenges of trigeminal neuralgia is the inability to predict when the next flare-up may happen. Especially severe flare-ups may produce so many pain attacks that the pain feels nearly constant. In severe or long-term cases of trigeminal neuralgia, an aching pain or light numbness may develop in the affected area of the face.
Causes and Risk Factors
The pain of trigeminal neuralgia is usually caused by pressure on the trigeminal nerve at the base of the brain. The pressure can be result from:
- A stroke that affects the lower part of the brain, where the trigeminal nerve enters
- A tumor that pushes on the nerve
- Contact between a normal artery or vein and the trigeminal nerve (the most common cause of trigeminal neuralgia)
- Injury to the nerve (such as from a car accident or head trauma)
- Surgery on the teeth and gums or the sinuses can also cause injury to the trigeminal nerve
- Multiple sclerosis, which causes damage to the nerves and can affect the trigeminal nerve
This condition occurs most often after the age of 50, although it has been found in children and infants. Women are nearly twice as likely to develop trigeminal neuralgia as men are.