Migraine Comorbidities: Trigeminal Neuralgia

Trigeminal neuralgia, also known as tic douloureux, is a chronic nerve disorder that causes one-sided, sudden bouts of stabbing, burning or shooting pain in the face that can eventually evolve into constant pain. Trigeminal neuralgia is commonly experienced by patients living with migraine disease and other headache disorders, such as cluster headaches.

The condition involves one the largest sets of nerves in the head, the trigeminal nerves. The trigeminal nerves are one of 12 pairs of nerves in the head that start at the base of the brain. The trigeminal nerves have three branches, an upper, middle and lower, which transmit sensations from different sections of the face to the brain. Some or all three branches may be affected by trigeminal neuralgia.

Trigeminal neuralgia is most often thought to be caused by the pressure of a blood vessel resting on the nerves. It is also associated with multiple sclerosis. Rarely it is associated with pressure from a tumor. In some patients a cause is never identified.

Patients typically experience the painful sensations associated with trigeminal neuralgia when they engage in activities that involve contact with or movement of the face, such as shaving, putting on makeup, brushing teeth, eating, drinking, talking, etc.

There are a variety of treatments available for patients living with this condition. Botox injections have been successfully used for treatment of both trigeminal neuralgia and migraine. There is also overlap among medications that have proven useful for both conditions, such as anticonvulsants, antidepressants and muscle relaxers.

Additionally, some patients find relief with surgerical procedures. This can include options such as cutting or destruction of the trigeminal nerves, radiofrequency nerve ablation, electrostimulation or gamma knife radiosurgery. If a tumor or blood vessel is thought to be the cause of the patient’s pain, there are surgical procedures to address these issues.

The Facial Pain Association (formerly the Trigeminal Neuralgia Association) is a great source of information and support for people living with trigeminal neuralgia. Visit their website at: www.fpa-support.org

Do any of you live with this condition? What treatments, if any, have been helpful for you?

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
1. “Trigeminal Neuralgia.” PubMed Health. May 21, 2012. Accessed October 30, 2012. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001751-. 2. “Trigeminal Neuralgia Fact Sheet.” National Institutes of Neurological Disorders and Stroke. September 19, 2012. Accesssed October 30, 2012. http://www.ninds.nih.gov/disorders/trigeminal_neuralgia/detail_trigeminal_neuralgia.htm-


View Comments (5)
  • Laura
    6 years ago

    Thank you for the reply Nancy. Yes – I’ve checked out the FP website. What I’d like to know is if the gamma knife procedure will also relieve the other symptoms such as weakness, light sensitivity, etc.

  • Nancy Harris Bonk moderator
    6 years ago

    Hi Laura,

    I don’t think so, but I will check and get back to you. I think it is just to relieve pain.

  • Laura
    6 years ago

    In addition to chronic migraine, I have been diagnosed with atypical trigeminal neuralgia. This means the pain is more dull and constant when compared to “typical” trigeminal neuralgia. I had a trial with a nerve stimulator using leads above my eye and in my cheek. The electrical stimulation soothed the pain in my cheek but not the pain in my eye. The leads could not be placed close enough to my eye to interfere with the nerve pain behind my eye. So I was not recommended for a permanent implant of a stimulator. That was terribly disappointing.

    I have also been through trials of numerous drugs (anti-seizure, anti-depressants, opiates, NSAIDs). Now I am on Cymbalta. It isn’t doing much for the facial pain, but it seems to have reduced the number of migraines.

    My neurologist has recommended that I go see a specialist in targeted radiation used to partially ablate the nerve.

  • Nancy Harris Bonk moderator
    6 years ago

    Hi Laura,

    Thanks for sharing your story with us. One of my very best friends who passed away from complications of MS, had horrible TN. She was very debilitated from MS and to see her suffer with TN was awful. Have you had a chance to check out that website Diana suggested?

  • Ellen Schnakenberg
    6 years ago

    Yes, unfortunately I do. The pain is excruciating and is not connected only to my Migraine attacks, although it is always worse during a Migraine.

    Atypical face pain should also be considered for Migraineurs who suffer pain in the face.

    A physician who operated on a friend’s TN designed a diagnostic tool for facial pain. I usually encourage patients to take the test and print out the results to take to their doctors if they think they may have TN.

    OHSU Brain Institute diagnostic tool: https://neurosurgery.ohsu.edu/tgn.php

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