Trigeminal Neuralgia and Facial Pain
Trigeminal neuralgia causes sudden, sharp jolts of pain on one side of the face, often set off by everyday things like chewing or touching your cheek. It is one of several causes of facial pain that a headache specialist can help sort out.
What is trigeminal neuralgia?
“Neuralgia” means nerve pain. The trigeminal nerve is the main nerve that carries feeling from your face and the front half of your head. When this nerve is irritated, it can send out sudden bursts of pain.
Trigeminal neuralgia usually affects one side of the face. Having it on both sides is very uncommon. The pain tends to strike the same spot each time. Between bursts, there is usually no pain at all.
Common symptoms
- Sudden, sharp, shooting or stabbing pain that feels like an electric shock
- Quick “zaps” of pain, often lasting only seconds
- Pain anywhere in the face, usually on one side
- No pain between bursts
- Runs of attacks that may go on for hours, and cycles that can last weeks or months
Steady, constant face pain is less typical of trigeminal neuralgia. It may point to another cause, such as migraine.
What causes it, and what can trigger an attack
In about half of cases, something presses on the trigeminal nerve, most often a loop of a blood vessel. In about 1 in 5 cases, no cause can be found. Sometimes another condition is behind the pain. For example, multiple sclerosis (a disease that affects the nerves of the brain and spinal cord) has been found in some people with these symptoms.
Attacks are often set off by light, harmless touches or movements, such as:
- Touching your face
- Chewing, talking or laughing
- Brushing your teeth
- Shaving or putting on makeup
- A breath of cold air on your face
Other causes of facial pain
“Facial pain” describes where pain is, not what is causing it. Several different conditions can cause it, and a person can have more than one at the same time. How the pain feels and how long it lasts often tell more than where it is.
- Migraine: a common cause of face pain. Migraine can hurt in the cheeks, around the nose or behind the eye, and can even cause a stuffy or runny nose. Some people treated over and over for “sinus headaches” turn out to have migraine. See migraine.
- Sinus problems: sinus inflammation can cause real pain. An ear, nose and throat (ENT) doctor can check for it, often with a small scope in the nose.
- TMD: temporomandibular disorders affect the jaw joints and the chewing muscles. Pain when opening the mouth wide, chewing or talking may suggest TMD. See TMD and jaw pain.
- Muscle (myofascial) pain: tight muscles in the face or head can send pain to other places, even making a tooth hurt.
- SUNCT and SUNA: rare headaches with brief, one-sided pain like trigeminal neuralgia, but with a red or watery eye, stuffy nose or runny nose. See SUNCT and SUNA.
- Primary stabbing headache: brief stabs of pain that move around the head instead of staying in one spot.
- Burning mouth syndrome: a burning feeling inside the mouth, often on the tongue.
If a dentist finds no tooth problem on exam or x-ray, ongoing mouth or tooth pain may be coming from muscles, a nerve problem or a headache disorder.
How it is diagnosed
Your doctor will ask detailed questions about your pain. It helps to note where it is, whether it is constant or comes and goes, how long it lasts, what sets it off, and any other symptoms. Words like “electric” or “shock” suggest a nerve is involved.
Headache specialists recommend imaging, such as a scan of the brain, for trigeminal neuralgia. It can show whether a blood vessel is pressing on the nerve, and it can rule out other, sometimes serious, causes.
Treatment options
- Anti-seizure medicines (anticonvulsants) are the usual first approach. Carbamazepine and oxcarbazepine are examples. They are generally taken steadily over weeks or months.
- Nerve blocks (injections of numbing medicine near a nerve) and other ways of blocking the trigeminal nerve may be options. They are not usually the first choice.
- Botox injections are used off label, meaning they are not FDA-approved for this condition. Studies and clinical experience suggest they may help some people, but they are not a first-line treatment.
- Surgery to move a blood vessel off the nerve may be considered when appropriate, usually only after several other treatments have not helped. Surgery carries its own risks.
For other kinds of facial pain, treatment depends on the cause. Sleep, diet, mood and daily habits are also part of care for many headache and face pain conditions.
How Dr. Park can help
Dr. Hannah Park is a dual board-certified, fellowship-trained headache medicine neurologist with over 10 years of specialized experience, and she has lived with migraine herself. She treats trigeminal neuralgia and facial pain, as well as TMD and jaw pain.
Every patient starts with a 90-minute new patient consultation with Dr. Park ($520): a full history review, a neurological exam, a diagnosis and a personalized treatment plan. The practice focuses on targeted injection treatments, such as peripheral nerve blocks and Botox injections, rather than a cycle of prescription medications. If appropriate, an injection may be done during your first visit for an added fee. See services and fees.
Appointments are Monday to Friday, 9 a.m. to 6 p.m., usually within days. The practice is direct pay with no referral needed.
Related
Sources
This page summarizes patient information from these organizations, in our own words. It is general education, not medical advice.
- Facial Pain, Headache, & Migraine: What is the Difference?, National Headache Foundation
- Understanding Headache Locations, National Headache Foundation
- The Complete Headache Chart, National Headache Foundation
- Neuralgia del Nervio Trigémino: Tic Doloroso, National Headache Foundation
- Orofacial Pain: An Introduction, American Migraine Foundation
Last updated October 27, 2026.
Find out what is behind your face pain
Every patient starts with a 90-minute new patient visit with Dr. Park.