Trigeminal Neuralgia: Sharp, Electric-Shock Facial Pain and What to Do

What it involves

The MedlinePlus encyclopedia explains that trigeminal neuralgia is a nerve disorder that causes a stabbing or electric shock-like pain in parts of the face. The pain comes from the trigeminal nerve, which carries touch and pain sensations from the face, eyes, sinuses and mouth to the brain.

Who this is for

• Adults with brief, sharp, electric-like pain on one side of the face.
• Patients whose facial pain is set off by chewing, talking, smiling, brushing teeth or touch.
• People who had dental work done without finding a cause for the pain.
• Anyone with multiple sclerosis or a past face or mouth injury and new facial pain.

What to expect

• Questions about where the pain is, how long attacks last and what triggers them
• A nervous system exam of the face, eyes, jaw and cranial nerves
• Blood work, which the practice offers, to look for other causes
• A referral to a neurologist, a pain specialist or for brain imaging when it is needed

What the attacks are like

According to the MedlinePlus encyclopedia, the spasms are usually brief, but they may occur so close together that they feel like they last from several seconds to minutes, and in some people the pain becomes constant. It is usually on one side of the face, most often the right, and a neurological exam is often normal. Everyday triggers include talking, smiling, brushing teeth, chewing, drinking, eating, shaving, applying make-up, wind and hot or cold temperatures. In some people the condition goes away on its own.

What can cause it

MedlinePlus lists multiple sclerosis or other diseases that damage the covering of the nerves, pressure on the trigeminal nerve from a swollen blood vessel or a tumor, and injury to the nerve from facial trauma or oral or sinus surgery. Often no exact cause is found. It usually affects adults above age 50 and women more often than men, and in people younger than 40 it is often due to multiple sclerosis or a tumor. The multiple sclerosis guide describes that condition.

Pain that looks like something else

Face pain has many causes, and the tests are partly there to tell them apart. A jaw joint problem has its own pattern in the TMJ and jaw pain guide. Sinus pressure is covered in the sinus infection or cold guide, ear pain in the ear pain guide and a one-sided blistering rash in the shingles guide. The encyclopedia notes an eye exam is among the tests used to check for eye disease as a cause.

How it is worked up

The encyclopedia lists a complete blood count, an erythrocyte sedimentation rate, an MRI of the head, MRA or CTA of the brain, an eye exam, a spinal tap and, rarely, trigeminal reflex testing, to look for a cause. The practice offers blood work, and the complete blood count guide explains one of the tests. Brain imaging, eye exams and a spinal tap are arranged by referral, and your provider may involve a neurologist or a pain specialist.

Treatment is directed by a specialist

MedlinePlus says certain medicines can reduce pain and the rate of attacks, including anti-seizure medicines such as carbamazepine, muscle relaxants such as baclofen and tricyclic antidepressants. If multiple sclerosis is the cause, that condition is treated too. Surgery, nerve blocks and other procedures give short-term relief but carry risk, and they are specialist decisions. Never start or stop one of these medicines without the prescriber, and ask about side effects.

When to be seen and how it can affect daily life

Contact a provider for symptoms of trigeminal neuralgia or if they worsen. The encyclopedia lists complications that include weight loss from not eating to avoid triggering pain, avoiding other people if talking triggers pain, depression and high anxiety during attacks. If you feel hopeless, call or text 988, the Suicide and Crisis Lifeline, or call 911. The depression screening guide explains how mood is checked. Facial droop with weakness is a different problem, covered in the Bell's palsy guide.

Sources

• MedlinePlus Medical Encyclopedia: Trigeminal neuralgia
• MedlinePlus: Trigeminal Neuralgia