Trigeminal neuralgia: what it feels like and what to do

Trigeminal neuralgia is a short, intense shock-like pain on one side of the face. It can hit while you chew, brush your teeth, talk, or when wind touches your cheek. For many people the pain comes in bursts that last seconds to minutes, then calms down. Knowing how to spot triggers and when to seek help makes a big difference.

Common causes and red flags

Most cases come from pressure on the trigeminal nerve near the brainstem, often from a blood vessel. Other causes include nerve damage, tumors, or multiple sclerosis. See a doctor right away if you have numbness, muscle weakness, trouble moving your face, or if the pain is getting steadily worse—these signs can mean a different problem that needs fast attention.

Practical treatment options

First-line treatment is usually medicine. Carbamazepine and oxcarbazepine often reduce or stop the attacks. Gabapentin (Neurontin) and pregabalin are used when those drugs aren’t suitable or cause bad side effects. Medicines take time to find the right dose, and some require blood tests to check liver function and blood counts—ask your doctor what to watch for.

If medications don’t help or cause too many side effects, procedures and surgeries are options. Nerve blocks, Botox injections, and radiofrequency ablation can reduce pain for months to years. Microvascular decompression (MVD) is a surgical option that removes the vessel pressing on the nerve; it can give long-lasting relief but carries surgical risks. Less invasive choices like Gamma Knife radiosurgery are an alternative for people who can’t tolerate open surgery. Always get a neurosurgeon or pain specialist opinion before choosing a procedure.

Simple self-help matters. Keep a pain diary to track triggers and treatment effects. Eat softer foods if chewing sparks attacks. Avoid sudden movement, harsh cold, or tight scarves that press the face. Manage stress and sleep—both can lower how easily pain starts.

Medication safety tips: don’t stop anti-seizure drugs suddenly, because that can cause rebound problems. Tell your provider about all medicines and supplements you take—some drugs interact. If a medicine causes serious dizziness, confusion, or vision issues, call your doctor right away.

If you want more detail on specific drugs, our site covers gabapentin side effects and other migraine and facial pain options. Talk openly with your healthcare team about goals: fewer attacks, fewer side effects, or longer-lasting relief. With the right plan, many people regain normal activities and reduce pain episodes significantly.