A sudden electric shock in the face that disappears in seconds may not sound alarming at first. But for many, it marks the beginning of a painful neurological condition that quietly takes over daily life. Trigeminal neuralgia, often misunderstood and misdiagnosed, turns the simplest actions into triggers for intense facial pain.
Explaining the nature of the condition, Dr Y Muralidhar Reddy, senior consultant & head, department of neurology at Renova Century Hospitals, Banjara Hills, says that trigeminal neuralgia is linked directly to the nerve that carries sensation to the face. “Trigeminal neuralgia causes episodes of intense facial pain that can disrupt one’s daily activities. It is a disease of the trigeminal nerve – the fifth cranial nerve. This nerve provides sensation to your head and face. This is a type of neuropathic pain which arises due to damage or compression of these nerve fibres,” explains Dr Muralidhar Reddy.
In many cases, the early signs are brushed off as routine dental or sinus trouble. Patients often wait months before seeking the right medical help. Pointing to this pattern, Dr Sandeep Nayani, consultant neurologist at Apollo Hospitals, Jubilee Hills, explains, “In the early stages, patients may experience brief, sharp facial pain that comes and goes. The pain is often described as stabbing, shooting, or burning, and usually lasts for a few seconds to minutes but can recur frequently throughout the day,” says Dr Sandeep.
While ageing remains a major risk factor, the condition is not limited to seniors. Dr Muralidhar explains, “The most common type (primary) results from nerve compression by a blood vessel (usually the superior cerebellar artery). The less common type (secondary) is caused by nerve damage due to multiple sclerosis, a tumour or an arteriovenous malformation. It is designated idiopathic when no cause is found. People at risk include uncontrolled blood pressure, active smoking, increased age, and female gender.”
The diagnosis depends more on listening to the patient than on laboratory tests. Discussing how doctors identify the disorder, Dr Sandeep reveals, “Diagnosis is primarily based on the patient’s history and clinical symptoms. The pattern, location, and nature of pain give strong clues. An MRI scan is usually advised to rule out tumours, multiple sclerosis, or abnormal blood vessels compressing the nerve. There is no single blood test to confirm trigeminal neuralgia.”
Meanwhile, Dr Muralidhar explains about the treatment process, stating, “Medication is often the first therapy. These include anti-seizure medications such as carbamazepine, oxcarbazepine, and gabapentinoids such as gabapentin and pregabalin, as well as sodium channel blockers such as lamotrigine, lacosamide, topiramate, and phenytoin. If the medication does not work, surgery may be offered. These include surgery for rhizotomy, radiosurgery, microvascular decompression and peripheral neurectomy (local alcohol injection).”
Even everyday movements like chewing, talking or stepping into cold air can trigger attacks. “Patients are advised to identify and avoid known triggers as much as possible. Covering the face in cold weather, avoiding very hot or cold foods, eating soft food, and maintaining good oral hygiene can help reduce attacks. Stress management and adequate rest also play a role, as fatigue and anxiety can worsen pain episodes,” notes Dr Sandeep, adding that lifestyle adjustments make a real difference.
Living with trigeminal neuralgia can be unpredictable. Some patients experience long pain-free periods, while others battle recurring or worsening attacks. Doctors point out that medicines may lose their effect over time, making long-term monitoring essential. With timely diagnosis, regular follow-ups and the right treatment plan, most patients can still reclaim control over their daily lives.