Trigeminal neuralgia (TN) is a facial pain condition affecting the trigeminal nerve. It causes brief but recurrent attacks of stabbing or electrical shock sensations. It can be a symptom of multiple sclerosis (MS), which happens when a person’s immune cells damage the myelin sheath of their nerve cells, causing sensitivity and pain.

In the United States, around 12 out of every 100,000 people receive a TN diagnosis annually. According to the MS Society in the United Kingdom, individuals with MS are 20 times more likely to experience TN than those without. MS currently affects 2.5 million individuals worldwide.

Some studies have found that TN often precedes an MS diagnosis. Given the prevalence of TN in those with MS, further research is necessary to understand the link.

This article explains the links between TN and MS and the possible causes. It also discusses the diagnosis and treatment for both conditions.

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According to the National Institute of Neurological Disorders and Stroke (NINDS), TN can be a symptom of the autoimmune condition MS. In MS, immune cells travel into the brain and spinal cord and damage the cells that make the myelin sheath and the myelin itself.

Myelin is the protective coating around the axon — the message-carrying part of nerve cells. Messages have difficulty getting through the damaged myelin and cause symptoms. This type of damage to the trigeminal nerve results in TN.

TN is more common in people with MS than in the general population. For instance, a Finnish study from 2020 found that 2.1% of people with MS had TN.

Sex and gender exist on spectrums. For the purposes of this article, we use “male” and “female” to refer to a person’s sex assigned at birth. Learn more.

Symptoms of TN include a sudden, brief, stabbing, or electrical shock sensation that repeats and returns. It usually affects one side of the face and roughly aligns with the position of the trigeminal nerve, which has three main branches responsible for sensations in the head:

  • Ophthalmic division: This nerve is responsible for sensations in the forehead, eyeball, lacrimal glands or tear ducts, upper eyelids, frontal sinuses, and side of the nose.
  • Maxillary division: This nerve is responsible for the middle third of the face.
  • Mandibular division: This nerve is responsible for the lower jaw, including the attached teeth, the temporomandibular or jaw joint, the mucous membrane of the mouth, and the front two-thirds of the tongue.

The sudden pain attacks from TN can last from a fraction of a second to 2 minutes.

Read more about TN.

Research suggests that injury to the protective covering, or myelin sheath, surrounding nerve fibers in critical brain regions is the most common cause of TN in people with MS.

Stimulating the skin or mucous membranes around the trigeminal nerve regions can also trigger attacks.

Triggers

Activities that can trigger an attack include:

  • washing or shaving
  • talking or smiling
  • loud noises
  • chewing or swallowing
  • applying makeup
  • kissing
  • moving the head
  • drinking
  • teeth brushing
  • breezes or air conditioning
  • hot, cold, or spicy food
  • vibration from walking or car journeys
  • fampridine — a medication to treat MS

Doctors have not yet found a cure, but a range of treatments may help relieve the symptoms of TN.

Medications

Drug therapy options include:

  • Carbamazepine (Tegretol): This is an MS medication that treats pain linked to excessive muscle stiffness and spasms, TN, and other pain symptoms.
  • Baclofen: This can help ease pain by relaxing the muscles.
  • Oxcarbazepine (Trileptal): This is a medication for treating seizures.
  • Lamotrigine (Lamictal): This is an antiepileptic drug.
  • Gabapentin (Neurontin): This is an MS medication for treating nerve pain, numbness, burning, or pins and needles.
  • Pregabalin (Lyrica): This is a medication for reducing various types of pain by calming overstimulated nerve cells.

Surgery

Depending on a person’s symptoms and the severity of their condition, doctors may recommend one of three types of surgery.

These include percutaneous treatments, which doctors deliver under the skin and deliberately injure the trigeminal nerve. Doctors administer these treatments at the Gasserian ganglion, where the three main branches of the trigeminal nerve meet. This disrupts the pain signals.

Examples include:

  • glycerol injections
  • gamma knife or radiofrequency lesioning, which is applying heat using a needle
  • balloon compression, which involves inserting a tiny balloon along a thin tube through the cheek and inflating it to squeeze the ganglion, then removing the balloon
  • Botox injections

Stereotactic radiosurgery is another option. It uses a concentrated radiation beam to injure the trigeminal nerve and block the pain signals. It starts to work within a few weeks and may relieve pain for months or even years.

People with TN caused by a blood vessel pressing on the trigeminal nerve may find relief from microvascular decompression. It involves moving the blood vessel away from the nerve. A person must undergo a general anesthetic to have this treatment. This is because it is a major operation that involves opening up the skull.

Read more about pain and the various ways to treat it.

Management

In addition to drug and surgical options, a person can try a range of other therapies to reduce the effects of TN.

For instance, some people may find relief through:

Additionally, a person can avoid triggers, as listed in the above section.

A person’s MS treatment will depend on how advanced the disease is and their specific set of symptoms. They may receive treatment:

  • for relapses of MS symptoms, using steroids
  • for specific MS symptoms, such as TN
  • to lower the number of relapses, known as disease-modifying therapy

Visit our hub to learn more about MS.

Doctors can have difficulty diagnosing TN due to a lack of specific diagnostic tests and symptoms similar to other conditions that cause facial pain. However, it is a common symptom in people with MS.

Anyone who feels an unusual, sharp pain around their eyes, lips, nose, jaw, forehead, or scalp and who has not recently had dental or facial surgery should talk with a doctor.

People who experience TN may experience complications of the disease itself or due to treatments for the condition.

Complications of the condition include:

  • pain so severe and debilitating that it results in depression if a person does not receive treatment
  • pain so severe that it results in facial twitches that cause a person to withdraw socially due to embarrassment and worry about their next attack
  • permanent numbness on the affected side of the face
  • corneal anesthesia — a reduced sensation of the clear covering of the eye — and jaw weakness
  • anesthesia dolorosa — an uncontrollable and unpleasant sensation on the face, such as burning, tingling, itching, or stinging, which can have more of a negative effect than TN itself

Long-term anticonvulsant use can also cause adverse effects, while microvascular decompression and percutaneous procedures come with the usual risks associated with surgery.

TN is not life threatening but can cause lifelong pain and disablement. Some people experience it for weeks or months, followed by periods free of pain, while others have constant background facial pain. In some people, the attacks get longer and more frequent. Medications may also become less effective over time.

With a correct diagnosis and appropriate management, a person can expect a positive outlook.

TN is more common in people with MS than in the general population. It is a pain condition affecting the parts of the face that get their sensation from the trigeminal nerve.

Triggers include activities such as washing, shaving, chewing, or talking. Several treatments may help relieve symptoms, including medications, surgery, and avoiding triggers where possible.