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Neurosciences and Behavioral Health Center

Trigeminal Neuralgia

Trigeminal neuralgia (TN) is a disorder of the trigeminal nerve (fifth cranial nerve) that causes severe, shooting pain along one side of the face. The trigeminal nerve senses touch, pain, pressure and temperature. It also helps make saliva and tears.

The location of the trigeminal nerve along the right side of the head.

The Trigeminal Nerve
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In TN, pain usually lasts for less than a second to a few seconds and may come and go for days, weeks, months or years. It may go into remission or stop completely for months or years. Over time, though, the attacks may become more frequent and more severe.

Causes & Risk Factors

Sometimes, blood vessels can compress a nerve and cause TN problems. Rarely, TN may occur as a symptom of another underlying disorder, such as:

  • Tumor in the brain or head
  • Multiple sclerosis
  • Shingles

TN is more common in women aged 50 years or older. Having certain medical conditions, such as multiple sclerosis or high blood pressure, may increase your risk of TN.

Trigeminal Neuralgia Symptoms

The main symptom is searing pain on one side of the face. You may feel pain inside the mouth or in the lips, cheek, chin, nostril, ear or near the eye. Rarely, pain may occur in the eye or forehead. Twitching or wincing sometimes accompanies the pain.

The pain is typically sudden, severe and stabbing. Even though the pain is brief, usually less than two minutes, it can reoccur hundreds of times a day. Attacks can become totally disabling. They may seem to occur at random or be triggered by extremes of temperature, washing, shaving, touching or tickling the face. There are usually no symptoms between attacks, except perhaps a dull ache.


Treatment usually begins with medicine. If medicine fails, other options are available.


Medicines may include:

  • Carbamazepine
  • Other antiseizure medicines (e.g., phenytoin, gabapentin, lamotrigine, oxcarbazepine, pregabalin, topiramate)
  • Low-dose antidepressants (e.g., amitriptyline, clomipramine)
  • Muscle relaxer (e.g., baclofen)
  • Other medicines, such as sumatriptan (Imitrex) injection, lidocaine nasal spray


Surgical options can:

  • Remove the artery or tumor pressing on the nerve
  • Cut the trigeminal nerve

Surgery can be highly effective and most commonly uses microvascular decompression, a microsurgical technique that treats facial pain or spasm by removing pressure on nerves with tiny Teflon sponges.

Other Treatments

We also use these procedures, particularly in older patients:

  • Gamma Knife radiosurgery
  • Injections of alcohol or glycerin to deaden the nerve
  • Injections of pain relievers or steroids to decrease inflammation/irritation of the nerve.
  • High-frequency radio waves to deaden the nerve


Call 434.924.2706.


Content was created using EBSCO’s Health Library. Edits to original content made by Rector and Visitors of the University of Virginia. This information is not a substitute for professional medical advice.

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