Trigeminal Neuralgia: Facial Pain Specialist Answers Your Top FAQs

Trigeminal neuralgia is often described as one of the most severe types of pain a person can experience. It causes sudden, electric shock-like attacks on one side of the face that can make eating, brushing teeth, or even a light breeze feel unbearable.

Although it is a rare condition, it has a big impact on quality of life. Some estimates suggest that around 150,000 Americans are diagnosed with trigeminal neuralgia each year. The good news is that effective treatments exist, from medications to procedures such as microvascular decompression and radiosurgery.

Below, a facial pain specialist-style FAQ walks through the questions most people in San Diego ask when they first hear the words “trigeminal neuralgia”.

Quick Answer
Trigeminal neuralgia is a facial pain disorder caused by irritation or compression of the trigeminal nerve, usually on one side of the face. It leads to short bursts of intense, electric shock-like pain in the cheek, jaw, teeth, or lips, often triggered by light touch or daily activities.

Most patients start with medications such as carbamazepine or oxcarbazepine. When medicines stop working or cause significant side effects, a trigeminal neuralgia specialist in San Diego may discuss procedures like microvascular decompression, stereotactic radiosurgery, or percutaneous rhizotomy to reduce or relieve pain.

FAQ 1: What Is Trigeminal Neuralgia

The trigeminal nerve is the main sensory nerve of the face. It has three branches that supply the forehead and eye region, the cheek and upper jaw, and the lower jaw.

Trigeminal neuralgia (TN) is a long-lasting pain disorder where this nerve becomes irritated. Classic features include:

  • Sudden, severe, electric shock-like pain in the cheek, jaw, teeth, gums, or lips,
  • Pain almost always on one side of the face,
  • Attacks that last seconds to two minutes and may come in flurries.

Doctors often distinguish:

  • Classical TN, usually due to a blood vessel compressing the nerve near the brainstem,
  • Secondary TN, caused by another condition such as multiple sclerosis or a tumor,
  • Idiopathic TN, when no clear structural cause is found.

FAQ 2: What Causes Trigeminal Neuralgia

In many patients, trigeminal neuralgia is linked to a blood vessel pressing on the nerve where it enters the brainstem, called a neurovascular conflict. This repeated contact is thought to damage the nerve’s protective coating and make it fire pain signals more easily.

Other possible causes include:

  • Multiple sclerosis plaques affecting the nerve root,
  • Tumors in the posterior fossa that compress the nerve,
  • Less commonly, prior trauma or structural abnormalities.

Sometimes, no clear compression is seen on imaging, yet the pattern of pain still fits TN.

FAQ 3: What Are the Symptoms and Triggers

Typical symptoms include:

  • Sudden stabbing, shooting, or electric shock-like pain in the distribution of one or more branches of the trigeminal nerve,
  • Attacks lasting seconds, with pain-free intervals in between,
  • Bouts of repeated attacks over minutes or hours, sometimes with longer remission periods.

Common triggers are:

  • Light touch to the face,
  • Chewing, talking, smiling, or brushing teeth,
  • Washing the face or shaving,
  • Cold air or wind on the face.

Some people have no pain between attacks. Others develop background ache or burning sensation along with sharp shocks.

FAQ 4: How is Trigeminal Neuralgia Diagnosed

A facial pain neurosurgeon in San Diego or a neurologist typically diagnoses TN based on:

  • Detailed history
    • Location, quality, and timing of pain,
    • Specific triggers,
    • Response to prior treatments.
  • Neurologic examination
    • Facial sensation, corneal reflex, and other cranial nerves,
    • Signs that might suggest multiple sclerosis or other causes.
  • Imaging
    • MRI is usually recommended to rule out tumors and to look for blood vessels contacting the trigeminal nerve, especially high-resolution sequences focused on the nerve.

Diagnosis is mainly clinical, but imaging helps confirm the type of TN and guides treatment discussions.

FAQ 5: What Medications Are Used To Treat Trigeminal Neuralgia

Most patients start with medication. Evidence-based guidelines from the American Academy of Neurology and other expert groups consider:

  • Carbamazepine and oxcarbazepine as first-line drugs for classic trigeminal neuralgia,
  • These drugs act on sodium channels to calm abnormal nerve firing.

If first-line agents are not tolerated or stop working, other options may include:

  • Gabapentin, pregabalin, or baclofen,
  • Lamotrigine or other anticonvulsants,
  • Combinations of medicines tailored to side effect profiles.

Side effects can include dizziness, drowsiness, low sodium, or changes in liver function, so regular follow-up and blood tests may be needed. Over time, some patients find that medicine is less effective or that side effects become limiting, which is when procedural options may come into the conversation.

FAQ 6: When Should I See a Trigeminal Neuralgia Specialist in San Diego

You should consider seeing a trigeminal neuralgia specialist in San Diego, often a facial pain neurosurgeon or a multidisciplinary team, when:

  • Medications do not control your pain despite dose adjustments,
  • Side effects from medicines significantly reduce your quality of life,
  • Your pain pattern is changing, becoming more constant, or spreading,
  • MRI shows a structural cause, such as clear vessel compression, that might be treatable surgically.

A specialist can confirm the diagnosis, review imaging, and outline both surgical and non-surgical options that fit your health, age, and goals.

FAQ 7: What Is Microvascular Decompression (MVD)

Microvascular decompression (MVD) is a surgical procedure designed to relieve pressure on the trigeminal nerve. It is considered the main surgical treatment for classical TN when a blood vessel is compressing the nerve and when patients are healthy enough for a cranial operation.

In general terms, MVD involves:

  • A small opening in the skull behind the ear,
  • Gentle exposure of the trigeminal nerve at the brainstem,
  • Identification of the offending artery or vein that is compressing the nerve,
  • Repositioning of that vessel and placement of a small cushion between the nerve and vessel to prevent future contact.

The goal is to treat the underlying cause of classical TN by removing the neurovascular conflict while preserving the nerve itself. Studies and long-term series report high rates of meaningful pain relief for many patients, although outcomes vary and recurrences can occur over time.

FAQ 8: What Are My Options Besides Microvascular Decompression

Not everyone is a candidate for MVD. Age, other medical conditions, MRI findings, and personal preference all matter. Alternatives include:

  • Stereotactic radiosurgery, such as Gamma Knife, which uses focused radiation on the trigeminal nerve root to reduce pain signals without an open incision, usually as an outpatient procedure.
  • Percutaneous procedures, performed through a needle or small tube at the base of the skull, including:
    • Radiofrequency rhizotomy to heat and selectively injure pain fibers,
    • Balloon compression to briefly squeeze the nerve,
    • Glycerol injection to chemically damage part of the nerve.

These options often have shorter recovery times and are sometimes preferred for older or medically fragile patients, but they usually work by partially damaging the nerve and carry a higher chance of facial numbness. A facial pain neurosurgeon will explain how each option balances pain relief, risk of numbness, and likelihood of recurrence over time.

FAQ 9: What Is Recovery Like After Microvascular Decompression

Recovery from MVD varies, but general patterns from large centers include:

  1. A short hospital stay, often a few days,
  2. Incision soreness, fatigue, and mild headaches in the early period,
  3. Gradual return to normal light activities over a few weeks, with longer restrictions on heavy exertion.

Commonly discussed risks include:

  • Infection or bleeding,
  • Hearing changes on the operated side,
  • Cerebrospinal fluid leak,
  • Facial numbness or weakness,
  • In rare cases, more serious neurologic complications.

Your surgeon should review these in detail, along with expected benefits, so you can weigh them against the impact of ongoing pain.

Guideline note: Any recovery timeline after microvascular decompression is a general guideline only. Actual recovery depends on your age, overall health, specific anatomy, and how your body heals.

FAQ 10: Can Trigeminal Neuralgia Come Back

Yes, trigeminal neuralgia can recur even after successful treatment.

  • With medication, control can wane over time, requiring dose changes or new drugs,
  • After procedures such as MVD, radiosurgery, or percutaneous rhizotomy, many patients enjoy long-lasting relief, but some experience a return of attacks months or years later and may need retreatment or medication again.

This is why long-term follow-up with your trigeminal neuralgia specialist is important. Adjustments can often restore control or reduce the impact of symptoms.

Living With Trigeminal Neuralgia: Practical Tips

Daily life with TN can be challenging, but small adjustments often help:

  • Use lukewarm water for face washing and avoid very hot or cold extremes,
  • Choose softer foods during bad flares and chew on the less sensitive side,
  • Cover your face with a scarf in cold or windy weather,
  • Continue oral hygiene with a soft toothbrush or alternative tools to protect your teeth.

Because the condition can cause anxiety and fear of triggering pain, mental health support, either through counseling or support groups, can also be valuable.

When Should I Seek Urgent Care

Although trigeminal neuralgia itself is painful, it usually does not cause emergency neurologic damage. However, you should seek urgent evaluation if you notice:

  • New facial weakness or drooping,
  • Double vision or other visual changes,
  • Widespread facial numbness rather than localized trigger zones,
  • Sudden severe headache, unlike your usual attacks.

These signs may suggest a different or additional problem that needs immediate attention.

Final Thoughts

Trigeminal neuralgia is a serious facial pain condition, but it is also a treatable one. Many patients find significant relief with the right combination of medication, procedures, and long-term follow-up.

The most important steps are to obtain an accurate diagnosis, understand the cause in your particular case, and work closely with a trigeminal neuralgia specialist in San Diego who can explain all reasonable options, including microvascular decompression, radiosurgery, and percutaneous procedures when appropriate. No one should feel they must simply live with disabling facial pain without a thorough evaluation.

Key Takeaways

  • Trigeminal neuralgia causes sudden, electric shock-like facial pain, usually on one side, and is often triggered by light touch or routine activities.
  • First-line treatment is medical, most often carbamazepine or oxcarbazepine, with other medications available if needed.
  • MRI is recommended to rule out secondary causes and to look for blood vessel compression of the nerve.
  • When medications fail or cause significant side effects, options include microvascular decompression, stereotactic radiosurgery, and percutaneous rhizotomy, each with distinct profiles of benefit and risk.
  • Long-term follow-up with a facial pain neurosurgeon in San Diego helps manage recurrences, adjust treatment, and support quality of life.

If you are dealing with sudden, electric shock-like facial pain that sounds like trigeminal neuralgia, or if current treatment is no longer working, do not wait in silence. Schedule a consultation with a facial pain neurosurgeon in San Diego to review your symptoms, imaging, and treatment options, including microvascular decompression and less invasive procedures where appropriate. Early expert input may improve both pain control and long-term quality of life.

Dr. Sanjay Ghosh is a board-certified neurosurgeon at SENTA Clinic in San Diego, fellowship-trained in spine and cranial base surgery. This content is educational and not a substitute for personalized medical advice.

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