The Changing Face of Trigeminal Neuralgia

A Narrative Review

Stine Maarbjerg MD, PhD; Rafael Benoliel BDS (Hons)


Headache. 2021;61(6):817-837. 

In This Article

TN Attributed to Multiple Sclerosis

More than half of patients with MS report some type of pain during the course of their disease.[72,73] More than a quarter will experience central pain that is bilateral, constant, aching, burning, or pricking. Nonfacial pain may be a presenting symptom of MS in 5.5% of cases, alone or in combination with other signs.

TN in MS may be due to demyelination of the trigeminal nerve. Additionally, findings of NVC of the nerve root and positive outcome of MVD for these cases suggest that vascular malformations may also contribute to the appearance of TN in MS,[74] but the available studies are contradictive.[75] MS increases the risk of developing TN by a factor of 20. Clinical signs predictive of MS in patients with TN are bilateral pain (14% in MS) and young age.[76] Very rarely does TN herald the onset of MS; this was observed in only 0.3% of MS cases. In one cohort study of patients with TN with MS, TN preceded MS diagnosis in 19% of the cases.[74] Usually, TN develops in a person already diagnosed with MS, on average about 12 years after the onset of MS and occurs in 1.5%–7.9% of those with MS.[72,73,77]