Trigeminal neuralgia and MS

Jump to:

• What is trigeminal neuralgia?
• Causes of trigeminal neuralgia
• Symptoms of trigeminal neuralgia in MS
• Trigeminal neuralgia triggers
• What can be mistaken for trigeminal neuralgia?
• Trigeminal neuralgia treatment
• How to manage trigeminal neuralgia
• Dental health with trigeminal neuralgia
• Research into trigeminal neuralgia and MS
• Trigeminal neuralgia and MS relapse

What is trigeminal neuralgia?

Trigeminal neuralgia causes nerve pain on the side of the face, where the trigeminal nerve is. People often describe the feeling as a sudden, strong, sharp pain, which usually comes and goes, lasting a few seconds or minutes at a time. But the feeling can last longer. There's often a trigger for the pain, like brushing teeth or a cold wind in the face.

Trigeminal neuralgia is caused when the trigeminal nerve is damaged or compressed. Around 2 to 5% of people with MS experience trigeminal neuralgia at some time. People who don’t have MS can also get trigeminal neuralgia.

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Causes of trigeminal neuralgia

MS can cause trigeminal neuralgia, but people who don’t have MS can also have it. Depending on the cause, doctors might call it 'secondary trigeminal neuralgia' or 'classic trigeminal neuralgia'.

Secondary trigeminal neuralgia

When trigeminal neuralgia is caused by MS or a different health condition, it’s sometimes called ‘secondary trigeminal neuralgia’, 'idiopathic trigeminal neuralgia' or ‘atypical trigeminal neuralgia. 

With MS, this happens when the protective ‘myelin’ coating around the trigeminal nerve or connections to deeper parts of the brain are damaged. 

Classic trigeminal neuralgia

Another cause of trigeminal neuralgia is when a blood vessel puts pressure on the trigeminal nerve. That’s sometimes called ‘classic trigeminal neuralgia’.

There is a usually something that triggers this kind of trigeminal neuralgia. For example, the pain happens when you brush your teeth.

Finding the cause 

To find out the cause of trigeminal neuralgia, a doctor might arrange an MRI scan or refer to other healthcare professionals. Finding the cause can help find the best treatment. But there might be more than one obvious cause. And some of the treatments offered could be the same whatever the cause.

With any new symptom, your doctor or MS team can also do a review of drug treatments you take. That helps rule out side-effects being a cause.

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Symptoms of trigeminal neuralgia in MS

The main symptom of trigeminal neuralgia is sudden and sharp pain in the face. The attacks can last from a fraction of a second to a couple of minutes. Some people describe trigeminal neuralgia pain as like electric shocks.

Trigeminal neuralgia normally only occurs on one side of the face. Very rarely, it can happen on both sides. But usually not at the same time.

For some people, trigeminal neuralgia is an occasional pain, while for others the sensation happens more often.

In between the attacks, some people still feel a dull burning or tingling sensation in the affected area.

There can be days, weeks or months, where the pain goes away entirely.

The trigeminal nerve

The trigeminal nerve has three branches, each connecting the brain to a different part of the face. In trigeminal neuralgia, one, two or all of the branches can be affected. So pain could be felt in the jaw, the teeth, the cheek, the forehead, the eye or all of those areas.

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Trigeminal neuralgia triggers

Trigeminal neuralgia pain is usually set off by touch or pressure on sensitive areas of the face. These are sometimes called “trigger points” or “trigger zones”.

It varies from person to person, but trigeminal neuralgia triggers might include some everyday activities like:

• shaving
• brushing your teeth
• washing your face
• putting on make-up
• speaking
• eating
• exposure to hot or cold temperatures

People can have different triggers. But if they can be avoided it can help reduce trigeminal neuralgia pain. A healthcare professional can help find different ways to do things, and ways to manage pain.

Does eating bananas trigger trigeminal neuralgia?

Some people say that eating bananas triggers their trigeminal neuralgia pain. There’s currently no research to show this link or suggest you need to avoid eating bananas. But for some people, eating food can be a trigger, and the size and texture of foods might make a difference.

If you think certain foods or drinks might be triggers for your trigeminal neuralgia, you might want to keep a diary of what you eat. That could help to find any patterns between what you eat and when it's painful.

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What can be mistaken for trigeminal neuralgia?

Pain in the face might have other causes, rather than trigeminal neuralgia. For example, dental problems can cause pain in your jaw or teeth.

If you have pain around the eye, symptoms might be caused by optic neuritis. That's an inflammation of the optic nerve which can sometimes be painful.

If you’re experiencing any painful or troubling symptoms and you don’t know what’s causing it, contact your GP or MS team. They can help discover the cause of your pain. They might refer you to other specialists, including a pain clinic.

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Trigeminal neuralgia treatment

Before suggesting how to treat trigeminal neuralgia, doctors need to discover the cause. They might do an MRI scan to see if there’s something putting pressure on the nerve, or if it’s caused by MS damage to the myelin round the nerve. Sometimes, it can be caused by both of those things at once.

There are various trigeminal neuralgia treatments that can help, including medication, surgery and a type of radiation therapy.

Lots of different health care professionals could work together to find the right treatment for you. This ‘multi-disciplinary’ approach, for example, happens with a pain clinic. 

Medications for trigeminal neuralgia

Everyday painkillers like paracetamol and ibuprofen don’t usually help with nerve pain like trigeminal neuralgia. You might be prescribed a drug called carbamazepine – usually through a pain specialist, rather than your GP. It’s a tablet or liquid to swallow that can reduce the pain.

Carbamazepine tends to be highly effective at first, but it might stop working so well over time.

If that happens, or if you get unwanted side effects from carbamazepine, pain specialists might suggest other medications, including:

• oxcarbazepine
• lamotrigine
• gabapentin
• pregabalin
• baclofen

These medicines aren't officially approved for treating trigeminal neuralgia like carbamazepine is, but they’re sometimes prescribed ‘off label’ if they might help.

Infusions in hospital for trigeminal neuralgia

Sometimes severe attacks of trigeminal neuralgia can be treated with an infusion (a drip) in hospital. This could give quick relief while another treatment starts to work. For example, it could be an infusion of an anti-epileptic drug like phosphenytoin or phenytoin. Or a local anaesthetic like lidocaine.

'Percutaneous procedures' for trigeminal neuralgia 

Some people have percutaneous procedures to treat trigeminal neuralgia. They're types of surgery. ‘Percutaneous’ means through the skin. If you have these treatments you’d be sedated or under general anaesthetic while it happens.

The type of surgery can depend on what’s causing the trigeminal neuralgia. But all of these ways to treat trigeminal neuralgia work on the place below the skin where the three main parts of the nerve join together. It’s near the top of the jaw. It’s called the ‘Gasserian ganglion’.

Percutaneus procedures for trigeminal neuralgia include:

• Radiofrequency lesioning: the doctor uses a needle to put heat directly on that part of the nerve
• Balloon compression: a tiny balloon is inserted through the cheek using a thin tube. It's inflated around the Gasserian ganglion to squeeze it, then the balloon is removed
• Glycerol shots: a medicine called glycerol is injected around the Gasserian ganglion

'Stereotactic radiosurgery' for trigeminal neuralgia

Stereotactic radiosurgery – also known as gamma knife radiation surgery – focuses a tiny radiation beam on the trigeminal nerve. It aims to stop it transmitting pain signals. The treatment is 'non-invasive' – there's no need for general anaesthetic or any cuts in your cheek. It can take a few weeks before noticing the benefit, but the pain relief can last for months or even years.

'Microvascular decompression' for trigeminal neuralgia

Microvascular decompression is a type of neurosurgery to treat trigeminal neuralgia. It’s used when the cause is a blood vessel compressing the nerve. A surgeon moves the blood vessel away from the nerve with a Teflon patch, to relieve the pressure. You’d have general anaesthetic for the operation.

Botulinum toxin (Botox) for trigeminal neuralgia 

Botox is not licenced for trigeminal neuralgia, but there’s good evidence from clinical trials that it can help if medication can't be used. Some specialist pain clinics offer it. 

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How to manage trigeminal neuralgia

There are things you can do to try and manage trigeminal neuralgia alongside medication or surgery. For example, some people find complementary therapies can help, including acupuncture. It can be a matter of trying different things to find what works best for you.

Healthcare professionals can help you find things that might help. Your GP or neurologist might refer you to a pain clinic that specialises in managing and treating pain.

Exercise to relieve trigeminal neuralgia

There’s no clear evidence that exercise directly helps manage trigeminal neuralgia. But mindful activities like yoga could help to cope with the pain. It could also help with the emotional impact of trigeminal neuralgia.

Learn more about mindfulness

Learn more about yoga for MS and watch some introductory videos

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Dental health with trigeminal neuralgia

Trigeminal neuralgia can sometimes be made worse by dental issues like tooth decay and gum disease.

So it’s important to look after your dental health. If brushing your teeth is a trigger, a pain specialist or your dentist can suggest ways to adapt and still keep your teeth and gums clean.

Read more about oral health and MS and tips for looking after your teeth

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Research into trigeminal neuralgia and MS

Research into trigeminal neuralgia and MS is looking into treatments, and ways to identify who’s most likely to benefit from which treatment. For example, we recently funded a research project to improve the pain relief from stereotactic radiosurgery. That research tested the benefits of different doses of treatment, and different targets on the nerve.

Other researchers are looking at new drugs to treat the pain with fewer side effects. And how MRI can best help diagnose the cause, and guide treatment when it’s caused by compression from a blood vessel.

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Trigeminal neuralgia and MS relapse

Trigeminal neuralgia can affect people with relapsing remitting MS, and people with progressive MS. The best ways to treat and manage it will depend on the person more than the type of MS.

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