Trigeminal Neuralgia Symptoms: Facial Pain & Warning Signs

Quick Glance: Common Trigeminal Neuralgia Symptoms

Some of the symptoms of trigeminal neuralgia include:

Electric shock-type pain on the face
Pain that lasts for a few seconds to two minutes
Pain caused by chewing, talking, touch or even wind
Pain felt in the cheek, jaw, teeth, gum or lip area
Burning or aching sensation between attacks in some people
Pain triggered by brushing the teeth or washing the face
Repeated attacks separated by pain-free periods

Trigeminal Neuralgia Symptoms That Should Not Be Ignored

Certain symptoms of trigeminal neuralgia (TN) indicate a higher-risk presentation or a possible underlying cause that requires urgent investigation. Some of these symptoms and what they may indicate are:

Symptom or Pattern	What It May Indicate
Persistent facial numbness or reduced sensation	Possible trigeminal nerve damage or secondary trigeminal neuralgia
Pain affecting both sides of the face	An unusual presentation that needs investigation for an underlying neurological condition
Facial pain beginning before age 40	An uncommon age for typical TN and a reason to investigate secondary causes
Pain accompanied by other neurological changes	A possible underlying condition affecting the brain or cranial nerves
Pain pattern becoming substantially different from previous attacks	A need to reassess the diagnosis or underlying cause
Frequent attacks that make eating or drinking difficult	Significant functional impact with a risk of poor nutrition or dehydration
Persistent background pain between attacks	Trigeminal neuralgia with concomitant continuous pain or another facial pain disorder requiring evaluation

Why Do Trigeminal Neuralgia Symptoms Occur?

The symptoms of trigeminal neuralgia are caused when the trigeminal nerve (the fifth cranial nerve that divides into three branches, providing feeling to the forehead, cheeks, and jaw) becomes inflamed or pressed upon and consequently fires erroneously. This causes the shooting or sudden bursts of pain.

Two major mechanisms cause the symptoms:

Nerve compression by blood vessels: Most cases of classical trigeminal neuralgia involve a blood vessel, usually the superior cerebellar artery, compressing the trigeminal nerve root where it enters the brainstem. As a result of this compression, the myelin sheath, which protects the nerve, gets damaged.
Nerve damage from diseases: Secondary trigeminal neuralgia is caused by nerve damage from multiple sclerosis (which destroys the myelin sheath), tumours or arteriovenous malformations. In idiopathic trigeminal neuralgia, investigations do not identify a clear structural cause.

Trigeminal Neuralgia Symptoms That Require Immediate Medical Attention

Trigeminal neuralgia itself does not usually cause a medical emergency. However, urgent assessment is needed when facial pain occurs with symptoms suggesting another serious neurological or medical condition.

It is recommended to get medical attention if you experience:

New facial pain with weakness or paralysis of the face, arm or leg
Facial pain with difficulty speaking or sudden confusion
Sudden loss of vision or severe new visual disturbance
Loss of consciousness
A severe new headache with neurological symptoms
A painful blistering rash around the eye or forehead with eye symptoms
Facial pain so severe that the person cannot drink enough fluids
Thoughts of self-harm or suicide because of uncontrolled pain

Symptoms of Trigeminal Neuralgia Based on Type

The modern classification divides trigeminal neuralgia into classical, idiopathic and secondary forms. These forms and their associated symptoms are given in the table below:

Type of Trigeminal Neuralgia	Symptoms
Classical Trigeminal Neuralgia	Recurrent, severe electric shock-like or stabbing pain on one side of the face, usually triggered by light touch or everyday facial movements; some people also have continuous background pain
Idiopathic Trigeminal Neuralgia	Typical brief, severe and triggered facial pain, but investigations do not identify neurovascular compression with nerve changes or another clear cause
Secondary Trigeminal Neuralgia	Similar shock-like facial pain caused by another condition, such as multiple sclerosis or a structural lesion; numbness or other neurological abnormalities may also occur

Note: Symptoms alone may not reliably distinguish them, so imaging is important.

Symptoms of Trigeminal Neuralgia in Children

Trigeminal neuralgia is very rare in children and adolescents. When it occurs, the pain pattern may resemble adult trigeminal neuralgia, causing sudden, electric-shock-like severe pain that affects one side of the face.

A child may experience the following symptoms:

Suddenly stop eating or talking because of facial pain
Report sharp or electric shock-like pain in the cheek or jaw
Avoid touching or washing one side of the face
Develop pain while chewing or brushing the teeth
Experience repeated brief attacks separated by pain-free periods

Because trigeminal neuralgia is uncommon in childhood, recurrent neuralgic facial pain should be assessed by an appropriate specialist and investigated for possible secondary causes.

Can You Have Trigeminal Neuralgia Without Obvious Symptoms?

Trigeminal neuralgia cannot be completely symptom-free when an attack occurs because the condition is defined by recurrent facial pain. However, people may have no symptoms at all between attacks.

Pain-free periods can last for weeks, months or sometimes longer. This is known as remission. The pain may later return, so a long symptom-free period does not necessarily mean the condition has permanently resolved.

When Can Trigeminal Neuralgia Symptoms Become Life-Threatening?

Trigeminal neuralgia itself is not usually life-threatening. However, severe pain or symptoms from another underlying condition can occasionally create serious health risks. Some of these symptoms of trigeminal neuralgia include:

Symptoms	Why It Is Serious
Facial pain with sudden weakness, speech difficulty or confusion	These are not typical TN symptoms and may indicate a stroke or another acute neurological condition.
Facial pain with loss of consciousness or severe neurological deterioration	This may indicate a serious brain or neurological disorder requiring emergency assessment.
Severe pain preventing eating and drinking	Persistent inability to take fluids can lead to dehydration and poor nutrition.
Painful facial or forehead rash with eye pain or vision changes	This may indicate herpes zoster affecting the eye and requires urgent treatment.
Uncontrolled facial pain accompanied by thoughts of self-harm or suicide	Severe chronic pain can cause significant psychological distress and requires immediate mental health support.

How are Trigeminal Neuralgia Symptoms Diagnosed?

Trigeminal neuralgia is mainly diagnosed from the characteristic pattern of facial pain. There is no single blood test or laboratory test that confirms the condition. Some of the diagnostic tests used for trigeminal neuralgia are:

Diagnostic Test or Assessment	Purpose
Clinical history	Evaluates the pattern and triggers of facial pain.
Neurological examination	Checks for facial numbness, weakness, or abnormal reflexes.
MRI of the brain	Detects nerve compression, tumours, or multiple sclerosis.
MRI with FIESTA/CISS	Provides detailed images of the trigeminal nerve.
Trigeminal reflex testing in selected cases	May help evaluate trigeminal nerve function when MRI cannot be performed

FAQs

Q1. How does trigeminal neuralgia hurt?

Ans: Trigeminal neuralgia causes sudden, electric shock-like severe pain on one side of the face that lasts from a few seconds to two minutes.
Q2. What are the triggers for trigeminal neuralgia pain?

Ans: Touching the face, talking, chewing, smiling, brushing the teeth, washing the face, wearing makeup, or cold air/wind blowing on the face are some common triggers for trigeminal neuralgia-related pain.
Q3. What distinguishes trigeminal neuralgia from a toothache?

Ans: Trigeminal neuralgia can cause pain in the teeth, gums or jaw and may initially be mistaken for a dental problem. However, TN causes electric-shock-like pain triggered by touch. Toothache, on the other hand, causes a dull throbbing pain that worsens with eating.
Q4. Can trigeminal neuralgia occur on both sides of the face?

Ans: Bilateral trigeminal neuralgia - where there is simultaneous pain on both sides - is quite rare and can be due to some other underlying condition like multiple sclerosis. Usually, trigeminal neuralgia occurs unilaterally in the face.
Q5. Under what circumstances should one visit a neurologist for facial pain?

Ans: Trigeminal neuralgia symptoms should be assessed when severe, recurring facial pain is triggered by simple activities such as touching the face, eating or talking.
Q6. Is there any possibility that trigeminal neuralgia goes into spontaneous remission?

Ans: Symptoms of trigeminal neuralgia may improve for weeks or months, but the condition often returns and can worsen over time.
Q7. Does trigeminal neuralgia have any relation to multiple sclerosis?

Ans: Yes. Multiple sclerosis is a known cause of secondary trigeminal neuralgia, especially in younger adults.
Q8. Can the signs and symptoms of trigeminal neuralgia be mistaken for sinusitis?

Ans: Yes. Pain in the upper jaw, cheek, or forehead caused by trigeminal neuralgia may resemble sinusitis pain.

References
- https://www.mayoclinic.org/diseases-conditions/trigeminal-neuralgia/symptoms-causes/syc-20353344
- https://www.mayoclinic.org/diseases-conditions/trigeminal-neuralgia/diagnosis-treatment/drc-20353347
- https://my.clevelandclinic.org/health/diseases/15671-trigeminal-neuralgia-tn
- https://www.ninds.nih.gov/health-information/disorders/trigeminal-neuralgia
- https://www.ncbi.nlm.nih.gov/books/NBK544298/
- https://lonestarneurology.net/others/trigeminal-neuralgia-vs-tmj-disorder-telling-facial-pain-apart/
- https://www.rupahealth.com/post/differentiating-trigeminal-neuralgia-from-other-facial-pains-key-diagnostic-tools