What are the signs and symptoms of trigeminal neuralgia (TN)?

Updated: Jul 11, 2019
  • Author: Manish K Singh, MD; Chief Editor: Robert A Egan, MD  more...
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TN presents as attacks of stabbing unilateral facial pain, most often on the right side of the face. The number of attacks may vary from less than 1 per day to 12 or more per hour and up to hundreds per day.

Triggers of pain attacks include the following:

  • Chewing, talking, or smiling

  • Drinking cold or hot fluids

  • Touching, shaving, brushing teeth, blowing the nose

  • Encountering cold air from an open automobile window

Pain localization is as follows:

  • Patients can localize their pain precisely

  • The pain commonly runs along the line dividing either the mandibular and maxillary nerves or the maxillary and ophthalmic portions of the nerve

  • In 60% of cases, the pain shoots from the corner of the mouth to the angle of the jaw

  • In 30%, pain jolts from the upper lip or canine teeth to the eye and eyebrow, sparing the orbit itself

  • In less than 5% of cases, pain involves the ophthalmic branch of the facial nerve

The pain has the following qualities:

  • Characteristically severe, paroxysmal, and lancinating

  • Commences with a sensation of electrical shocks in the affected area

  • Crescendos in less than 20 seconds to an excruciating discomfort felt deep in the face, often contorting the patient's expression

  • Begins to fade within seconds, only to give way to a burning ache lasting seconds to minutes

  • Pain fully abates between attacks, even when they are severe and frequent

  • Attacks may provoke patients to grimace, wince, or make an aversive head movement, as if trying to escape the pain, thus producing an obvious movement, or tic; hence the term "tic douloureux"

Other diagnostic clues are as follows:

  • Patients carefully avoid rubbing the face or shaving a trigger area, in contrast to other facial pain syndromes, in which they massage the face or apply heat or ice

  • Many patients try to hold their face still while talking, to avoid precipitating an attack

  • In contrast to migrainous pain, attacks of TN rarely occur during sleep

See Clinical Presentation for more detail.

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