Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
According to a 2017 study, approximately 4% of people with MS experience trigeminal neuralgia. People with MS are far more likely than the general population to have an episode of the disorder where the lifetime prevalence is up to 0.3%.
This article discusses trigeminal neuralgia with MS, its symptoms, and how it is diagnosed and treated. It also lists other conditions that sometimes lead to similar neuralgia-like facial pain.
Trigeminal Neuralgia and MS Symptoms
Trigeminal neuralgia, sometimes calledtic doloureux(French for “painful twitch”), is perhaps the most intensely painful MS-related symptom.
The typical form of the disorder is calledType 1 (TN1), and it causes extreme, sporadic, sudden, electrical burning or shock-like pain that can last anywhere from a few seconds to two minutes. These attacks may occur in quick succession, last throughout a day, or wax and wane over the course of a day.
Both forms may occur in the same person, sometimes at the same time. Some researchers describe trigeminal neuralgia pain as among the worst possible pains to experience.The pain can be so extreme that a person becomes physically and mentally incapacitated.
Trigeminal neuralgia almost always occurs on one side of the face, although in people with multiple sclerosis, it may occur on both sides in about 18% of cases.
The trigeminal nerve provides sensation to the face and part of the ear and forehead. Therefore, the pain in trigeminal neuralgia can occur in any region of the face. However, it is usually distributed in one of the main branches of the trigeminal nerve. The most common areas are known as V1, V2 and V3.Pain often occurs in the V1 region (which is over the forehead) or V2, which is in the cheek and ear area.
Each episode of trigeminal neuralgia usually lasts a couple of weeks. Episodes tend to recur and can happen as often as every couple of months, although some people will go years between episodes.
Trigeminal Neuralgia Causes
A person can develop trigeminal neuralgia without having multiple sclerosis. In this instance, one can find changes in the trigeminal nerve root from vascular compression or no abnormalities at all.This type of trigeminal neuralgia is calledclassical trigeminal neuralgia.
The Anatomy of the Cranial Nerves
How Is Trigeminal Neuralgia Diagnosed?
A diagnosis of trigeminal neuralgia is based largely on a person’s history and description of symptoms, as well as on the results of a neurological examination. By touching and examining parts of your face, your healthcare provider can determine exactly where the pain is occurring and which branches of the trigeminal nerve may be affected.
You may also undergomagnetic resonance imaging (MRI)of your head to determine if MS or a tumor is causing trigeminal neuralgia.
Trigeminal neuralgia is also often mistaken for dental pain. This can lead to unnecessary (and irreversible) procedures like tooth extractions, root canals, and even procedures to reposition the jaw.
Some studies have looked at the role of potassium (found in food sources like bananas) and otherelectrolyteminerals as an underlying cause of trigeminal neuralgia. There is not yet reliable evidence to explain potassium, sodium, calcium, or other factors as a cause.
What Causes Electrolyte Imbalance and How to Treat It
Trigeminal Neuralgia and MS Treatment
If you have trigeminal neuralgia, your healthcare provider may prescribe either Tegretol (carbamazepine) or Trileptal (oxcarbazepine) to ease symptoms.Other medications may include:
If medication fails to relieve pain or produces unpleasant side effects, surgical treatment may be indicated.
Trigeminal neuralgia is a progressive disorder that often becomes resistant to medication over time.
Several neurosurgical procedures are available to treat trigeminal neuralgia, depending on the nature of the pain and the distribution of trigeminal nerve involvement.Surgical options include:
Trigeminal neuralgia can get so severe and distressing that it may require hospitalization and intravenous painkillers.It can also interfere with your ability to drink fluids, so these sometimes have to be given intravenously as well.
How to Find a Neurologist for Multiple Sclerosis
Summary
Trigeminal neuralgia is a condition that often affects people living with multiple sclerosis. The irritation and demyelination of the fifth cranial nerve can cause extreme pain in the face, cheek, and jaw.
Diagnosis usually involves a physical exam. Tests can be used to rule out other conditions, such as imaging used to make sure a tumor is not pressing on the nerve and causing pain.
Treatment can include medications (including Botox injections) and surgical procedures. Talk to your healthcare provider if you think you have trigeminal neuralgia symptoms related to MS.
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Fallata A, Salter A, Tyry T, Cutter GR, Marrie RA.Trigeminal neuralgia commonly precedes the diagnosis of multiple sclerosis.Int J MS Care. 2017;19(5):240-246. doi:10.7224/1537-2073.2016-065Gambeta E, Chichorro JG, Zamponi GW.Trigeminal neuralgia: An overview from pathophysiology to pharmacological treatments.Mol Pain. 2020;16:1744806920901890. doi:10.1177/1744806920901890Di Stefano G, Maarbjerg S, Truini A.Trigeminal neuralgia secondary to multiple sclerosis: from the clinical picture to the treatment options.J Headache Pain. 2019 Feb 19;20(1):20. doi:10.1186/s10194-019-0969-0.American Association of Neurological Surgeons.Trigeminal neuralgia: causes, symptoms and treatments.Lambru G, Zakrzewska J, Matharu M.Trigeminal neuralgia: a practical guide.Pract Neurol. 2021 Oct;21(5):392-402. doi: 10.1136/practneurol-2020-002782.Johns Hopkins Medicine.Trigeminal Neuralgia.Smith CA, Paskhover B, Mammis A.Molecular mechanisms of trigeminal neuralgia: A systematic review.Clin Neurol Neurosurg. 2021 Jan;200:106397. doi:10.1016/j.clineuro.2020.106397.Vargas A, Thomas K.Intravenous fosphenytoin for acute exacerbation of trigeminal neuralgia: case report and literature review.Ther Adv Neurol Disord. 2015;8(4):187-8. doi:10.1177/1756285615583202Additional ReadingCruccu G, Finnerup NB, Jensen TS, et al.Trigeminal neuralgia: new classification and diagnostic grading for practice and research.Neurology. 2016;87(2):220-8. doi:10.1212/WNL.0000000000002840Morra ME, Elgebaly A, Elmaraezy A, et al.Therapeutic efficacy and safety ofbotulinum toxin Atherapy in trigeminal neuralgia: a systematic review and meta-analysis of randomized controlled trials.J Headache Pain. 2016;17(1):63. doi:10.1186/s10194-016-0651-8National Institute of Neurological Disorders and Stroke.Trigeminal Neuralgia.
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Fallata A, Salter A, Tyry T, Cutter GR, Marrie RA.Trigeminal neuralgia commonly precedes the diagnosis of multiple sclerosis.Int J MS Care. 2017;19(5):240-246. doi:10.7224/1537-2073.2016-065Gambeta E, Chichorro JG, Zamponi GW.Trigeminal neuralgia: An overview from pathophysiology to pharmacological treatments.Mol Pain. 2020;16:1744806920901890. doi:10.1177/1744806920901890Di Stefano G, Maarbjerg S, Truini A.Trigeminal neuralgia secondary to multiple sclerosis: from the clinical picture to the treatment options.J Headache Pain. 2019 Feb 19;20(1):20. doi:10.1186/s10194-019-0969-0.American Association of Neurological Surgeons.Trigeminal neuralgia: causes, symptoms and treatments.Lambru G, Zakrzewska J, Matharu M.Trigeminal neuralgia: a practical guide.Pract Neurol. 2021 Oct;21(5):392-402. doi: 10.1136/practneurol-2020-002782.Johns Hopkins Medicine.Trigeminal Neuralgia.Smith CA, Paskhover B, Mammis A.Molecular mechanisms of trigeminal neuralgia: A systematic review.Clin Neurol Neurosurg. 2021 Jan;200:106397. doi:10.1016/j.clineuro.2020.106397.Vargas A, Thomas K.Intravenous fosphenytoin for acute exacerbation of trigeminal neuralgia: case report and literature review.Ther Adv Neurol Disord. 2015;8(4):187-8. doi:10.1177/1756285615583202Additional ReadingCruccu G, Finnerup NB, Jensen TS, et al.Trigeminal neuralgia: new classification and diagnostic grading for practice and research.Neurology. 2016;87(2):220-8. doi:10.1212/WNL.0000000000002840Morra ME, Elgebaly A, Elmaraezy A, et al.Therapeutic efficacy and safety ofbotulinum toxin Atherapy in trigeminal neuralgia: a systematic review and meta-analysis of randomized controlled trials.J Headache Pain. 2016;17(1):63. doi:10.1186/s10194-016-0651-8National Institute of Neurological Disorders and Stroke.Trigeminal Neuralgia.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Fallata A, Salter A, Tyry T, Cutter GR, Marrie RA.Trigeminal neuralgia commonly precedes the diagnosis of multiple sclerosis.Int J MS Care. 2017;19(5):240-246. doi:10.7224/1537-2073.2016-065Gambeta E, Chichorro JG, Zamponi GW.Trigeminal neuralgia: An overview from pathophysiology to pharmacological treatments.Mol Pain. 2020;16:1744806920901890. doi:10.1177/1744806920901890Di Stefano G, Maarbjerg S, Truini A.Trigeminal neuralgia secondary to multiple sclerosis: from the clinical picture to the treatment options.J Headache Pain. 2019 Feb 19;20(1):20. doi:10.1186/s10194-019-0969-0.American Association of Neurological Surgeons.Trigeminal neuralgia: causes, symptoms and treatments.Lambru G, Zakrzewska J, Matharu M.Trigeminal neuralgia: a practical guide.Pract Neurol. 2021 Oct;21(5):392-402. doi: 10.1136/practneurol-2020-002782.Johns Hopkins Medicine.Trigeminal Neuralgia.Smith CA, Paskhover B, Mammis A.Molecular mechanisms of trigeminal neuralgia: A systematic review.Clin Neurol Neurosurg. 2021 Jan;200:106397. doi:10.1016/j.clineuro.2020.106397.Vargas A, Thomas K.Intravenous fosphenytoin for acute exacerbation of trigeminal neuralgia: case report and literature review.Ther Adv Neurol Disord. 2015;8(4):187-8. doi:10.1177/1756285615583202
Fallata A, Salter A, Tyry T, Cutter GR, Marrie RA.Trigeminal neuralgia commonly precedes the diagnosis of multiple sclerosis.Int J MS Care. 2017;19(5):240-246. doi:10.7224/1537-2073.2016-065
Gambeta E, Chichorro JG, Zamponi GW.Trigeminal neuralgia: An overview from pathophysiology to pharmacological treatments.Mol Pain. 2020;16:1744806920901890. doi:10.1177/1744806920901890
Di Stefano G, Maarbjerg S, Truini A.Trigeminal neuralgia secondary to multiple sclerosis: from the clinical picture to the treatment options.J Headache Pain. 2019 Feb 19;20(1):20. doi:10.1186/s10194-019-0969-0.
American Association of Neurological Surgeons.Trigeminal neuralgia: causes, symptoms and treatments.
Lambru G, Zakrzewska J, Matharu M.Trigeminal neuralgia: a practical guide.Pract Neurol. 2021 Oct;21(5):392-402. doi: 10.1136/practneurol-2020-002782.
Johns Hopkins Medicine.Trigeminal Neuralgia.
Smith CA, Paskhover B, Mammis A.Molecular mechanisms of trigeminal neuralgia: A systematic review.Clin Neurol Neurosurg. 2021 Jan;200:106397. doi:10.1016/j.clineuro.2020.106397.
Vargas A, Thomas K.Intravenous fosphenytoin for acute exacerbation of trigeminal neuralgia: case report and literature review.Ther Adv Neurol Disord. 2015;8(4):187-8. doi:10.1177/1756285615583202
Cruccu G, Finnerup NB, Jensen TS, et al.Trigeminal neuralgia: new classification and diagnostic grading for practice and research.Neurology. 2016;87(2):220-8. doi:10.1212/WNL.0000000000002840Morra ME, Elgebaly A, Elmaraezy A, et al.Therapeutic efficacy and safety ofbotulinum toxin Atherapy in trigeminal neuralgia: a systematic review and meta-analysis of randomized controlled trials.J Headache Pain. 2016;17(1):63. doi:10.1186/s10194-016-0651-8National Institute of Neurological Disorders and Stroke.Trigeminal Neuralgia.
Cruccu G, Finnerup NB, Jensen TS, et al.Trigeminal neuralgia: new classification and diagnostic grading for practice and research.Neurology. 2016;87(2):220-8. doi:10.1212/WNL.0000000000002840
Morra ME, Elgebaly A, Elmaraezy A, et al.Therapeutic efficacy and safety ofbotulinum toxin Atherapy in trigeminal neuralgia: a systematic review and meta-analysis of randomized controlled trials.J Headache Pain. 2016;17(1):63. doi:10.1186/s10194-016-0651-8
National Institute of Neurological Disorders and Stroke.Trigeminal Neuralgia.
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