Chronic Face Pain: Could it be Trigeminal Neuralgia?

Chronic face pain can be both worrisome and difficult to live with, especially when the pain is deep, burning, and intense — and seemingly unexplainable.

When common causes of persistent face pain, such as chronic sinusitis, dental disease, facial trauma, headaches, and temporomandibular joint jaw dysfunction, have been effectively ruled out, it’s time to consider the possibility that your facial pain may be a symptom of a less common condition called trigeminal neuralgia. 

As a fellowship-trained neurosurgeon and trigeminal neuralgia expert, Jose Valerio, MD, knows just how debilitating this chronic pain problem can be. In this blog, he explores the causes, symptoms, triggers, and treatment options for this disruptive condition.  

Trigeminal neuralgia explained

Once described as “the most excruciating pain known to humanity,” trigeminal neuralgia is an intense facial pain condition that typically causes stabbing, electric shock-like pain through the cheek, lower face, jaw, teeth, and gums. Also called tic douloureux, this severe form of facial pain usually happens in short, unpredictable attacks that affect just one side of the face.

Causes

Trigeminal neuralgia occurs when something irritates the trigeminal nerve, a large nerve that sends pain, touch, and temperature sensations from your face to your brain. Rooted in your brain, the trigeminal nerve has branches extending across your forehead, through your cheek, and down into your jaw. 

Primary, trigeminal neuralgia is typically caused by trigeminal nerve compression, often at the base of the head where the brain meets the spinal cord. Usually the result of abnormal contact between the nerve and a nearby blood vessel, this compression puts pressure on the nerve and causes it to misfire. 

Secondary trigeminal neuralgia occurs when an abnormal growth, such as a tumor or a cyst, puts pressure on the nerve, or when a medical condition, such as multiple sclerosis (MS) or facial trauma, damages the nerve’s protective coating (myelin sheath).        

Statistics

About 150,000 people are diagnosed with trigeminal neuralgia each year in the United States. The condition affects adults over age 50 most often, and women are more likely than men to develop it. When trigeminal neuralgia occurs in someone aged 40 or younger, it often precedes an MS diagnosis.   

Common symptoms

For many people, trigeminal neuralgia first emerges as an unrelenting pain along the upper or lower jaw that’s often mistaken as a sign of a deep dental infection. But when this localized jaw pain persists, worsens, or spreads — despite professional dental care — it becomes clear that something else is wrong. There are two types of trigeminal neuralgia, and the symptoms depend on the type:

Typical trigeminal neuralgia (Type 1)

Type 1 trigeminal neuralgia is associated with intensely sharp pain attacks that may seem sporadic. You may feel throbbing, burning, or shock-like pain around your eyes, nose, lips, jaw, forehead, and scalp. These pain episodes may last anywhere from a few seconds to a couple of minutes, continuing for up to two hours with pain-free breaks between each attack.

Atypical trigeminal neuralgia (Type 2)

Less intense but often more widespread, Type 2 trigeminal neuralgia can cause constant face pain and generalized facial achiness punctuated by periodic stabbing or burning sensations. 

No matter its type, trigeminal neuralgia tends to run in cycles, causing lengthy stretches of frequent pain attacks followed by varying intervals (days, weeks, months, or even years) of little to no pain. The usual pattern, however, is for pain episodes to intensify as time goes on, with shorter pain-free periods in between.   

Common symptom triggers

Trigeminal neuralgia may seem sporadic, but its pain attacks are often triggered by simple facial contact, vibration, or movement. Common pain triggers include:

• Washing and drying your face 
• Applying and removing makeup
• Brushing and flossing your teeth
• Drinking hot or cold beverages
• Talking, smiling, or laughing

Sometimes, even a slight vibration across your skin, such as the kind caused by a light breeze, can be enough to trigger a trigeminal neuralgia pain attack.  

Getting relief from chronic facial pain

Although the condition itself is progressive and often life-altering, there are several treatment options that can help you lead a normal, relatively pain-free life. Depending on the specifics of your case, Dr. Valerio may recommend:

• Anticonvulsant medications  
• Tricyclic antidepressants
• Muscle relaxant medications
• Botox® or nerve block injections

If medication doesn’t provide effective relief, or if it causes intolerable side effects, Dr. Valerio may recommend surgical treatment. Options could include:

• Microvascular decompression (MVD) surgery
• Stereotactic radiosurgery (gamma knife radiosurgery)
• Percutaneous balloon compression surgery

Each procedure has specific benefits and drawbacks. For example, MVD surgery is the most invasive treatment option, but it’s also the most effective for providing long-lasting pain relief.

Balloon compression is a minimally invasive procedure, while gamma knife radiosurgery is completely noninvasive. Dr. Valerio explains the pros and cons of each option as they pertain to you, so you can make an informed decision about your care.  

If you’ve been living with unexplained facial pain, we can help. To get a thorough evaluation, book an appointment over the phone with the practice of Jose Valerio, MD, today. We have offices in South Miami, Hialeah, and Weston, Florida.