Trigeminal Neuralgia

Trigeminal Neuralgia (TN) is a nerve disorder that causes sudden, severe facial pain—often described as stabbing, electric, or shock-like. It affects the trigeminal nerve, which carries sensation from your face to your brain.

Pain usually comes in bursts or attacks, often on just one side of the face, and can be triggered by simple things like brushing your teeth, chewing, talking, or even a light breeze.

It can be incredibly debilitating, and unfortunately, it’s often misunderstood or misdiagnosed at first.

DSYG You’ve Got Trigeminal Neuralgia...

What causes Trigeminal Neuralgia?

Most cases of Trigeminal Neuralgia are caused by a blood vessel pressing on the nerve as it exits the brainstem. This constant pulsation irritates the nerve and causes it to misfire.

Other causes include:

Multiple sclerosis (which can damage the nerve’s protective coating)

Tumors or cysts pressing on the nerve (rare)

Trauma or prior surgery (scar tissue)

What can you do about it?

The first step is confirming the diagnosis—this usually involves an MRI to look for any structural cause and ruling out other problems.

Treatment options include:

🩺 Medication (often the first line):

Anticonvulsants like carbamazepine or oxcarbazepine help calm nerve signals.

These may work well early on, but side effects (like brain fog or fatigue) can become an issue.

🔪 Surgical options (if meds fail or side effects are too much):

Microvascular Decompression (MVD):
The most durable fix - "Gold Standard". A neurosurgeon moves the blood vessel off the nerve and pads it with a tiny cushion.

Glycerol Rhizotomy:
Destroys part of the nerve using strong alcohol injection - usually not as effective as MVD

Gamma Knife (stereotactic radiosurgery):
Focused radiation that disrupts the nerve over time.

How can you tell it is TGN versus sinus pain or tooth pain?

🚨 Electric shock-like facial pain, often triggered by talking, chewing, or cold air

🚨 Pain that is unilateral (on one side only - shouldn't cross midline)

🚨 Episodes that come and go but are becoming more frequent ("good days and bad days" often reported)

🚨 Medications that stop working over time or cause bad side effects

🚨 Pain so severe that self harm is considered. DON'T DO IT! The treatments work wonders!

If your imaging shows a blood vessel compressing a nerve, surgery may be advised.