Trigeminal neuralgia

Sudden, severe electric-shock facial pain. Among the most severe pains known, and it responds to the right drug.

What it is

Trigeminal neuralgia causes sudden, severe, electric-shock or stabbing pain in the face, lasting seconds to a couple of minutes, triggered by the lightest touch: a breeze, brushing teeth, chewing, talking.

It is usually caused by a blood vessel pressing on the trigeminal nerve. It affects around 10 in 100,000 people a year, mostly over 50.

It was historically called the suicide disease, which tells you how severe the pain is and why treating it quickly matters. That is not rhetoric: the pain is consistently rated among the most severe in medicine.

Ordinary painkillers do not work. Anticonvulsants such as carbamazepine do, and the response to them is so characteristic that it supports the diagnosis.

Signs you might notice

Sudden, brief, severe stabbing or electric pain on one side of the face.

Triggered by touch, wind, eating, brushing teeth, shaving, talking.

Periods of frequent attacks lasting weeks or months, then remission.

No pain between attacks, at least early on.

Bilateral pain, or pain in a young person, suggests another cause such as multiple sclerosis, and needs investigating.

How it can affect day-to-day life

The avoidance behaviours are what mark this out. People stop eating, stop brushing their teeth, stop talking, stop going outside in wind. Weight loss and dental disease follow.

Depression is common and directly proportionate to how long the pain has gone untreated.

Dental treatment is frequently attempted first, because the pain feels like teeth, and people undergo extractions and root canals that do nothing.

Supporting someone well

Get the right drug started. Carbamazepine is first line and it works for most people. Ordinary analgesics and opioids do not.

Do not have teeth removed on the basis of this pain without a neurological opinion.

Keep nutrition going during attacks: cold, soft, blended food, and a straw if touching the face is a trigger.

Support dental hygiene with the softest possible approach rather than abandoning it.

Ask about surgical options if medication fails or side effects are intolerable. Microvascular decompression has good long-term results.

Take the mental health impact seriously and ask about it.

Where to get help

Ask a GP for urgent referral to a neurologist, and for treatment to start meanwhile.

The Trigeminal Neuralgia Association UK run a helpline and hold a list of specialists.

Facial pain with other neurological symptoms, or in somebody under 40, needs imaging.