Understanding Different Types of Facial Pain (Part 1)

Trigeminal Neuralgia vs Trigeminal Neuropathy

Facial pain can be confusing and distressing, especially when it involves the trigeminal nerve, a major nerve responsible for sensation in the face. Two conditions often mistaken for one another are trigeminal neuralgia and trigeminal neuropathy.

Although both affect the same nerve, their causes, symptoms, and treatments differ significantly.

Understanding these differences can help patients and caregivers recognize the condition early and seek appropriate care.

AI generated model showing the trigeminal nerve branches on the face

What is the Trigeminal Nerve?

The trigeminal nerve is the fifth cranial nerve and the largest of the cranial nerves. It has three main branches:

• Ophthalmic (V1) – supplies sensation to the forehead, scalp, and upper eyelids.

• Maxillary (V2) – supplies the cheek, upper lip, and nasal cavity.

• Mandibular (V3) – supplies the lower lip, jaw, and some muscles used for chewing.

  
  

This nerve carries sensory information from the face to the brain and controls some motor functions. Damage or irritation to this nerve can cause intense facial pain or numbness.

1. What is Trigeminal Neuralgia?

Trigeminal neuralgia (TN) is a chronic pain condition characterized by sudden, severe, electric shock-like pain along one or more branches of the trigeminal nerve. It is often called the “suicide disease” because of the extreme pain it causes.

Causes of Trigeminal Neuralgia

The most common cause is blood vessel compression of the trigeminal nerve near its entry point to the brainstem.

This compression causes the nerve to malfunction and send pain signals without any real trigger. This is called "Classical Trigeminal Neuralgia". There are other varieties of Trigeminal Neuralgia including "Idiopathic", having no cause, and "Secondary" due to organic pathology along the branches of Trigeminal nerve. Examples of secondary TN include:

• Multiple sclerosis (MS)

• Tumors pressing on the nerve

• Facial trauma or surgery

Lambru G. et al Trigeminal neuralgia: a practical guide Practical Neurology 2021;21:392-402.

Symptoms of Trigeminal Neuralgia

• Sudden, sharp, stabbing pain episodes lasting seconds to minutes

• Pain triggered by light touch, chewing, speaking, or even a breeze

• Pain usually affects one side of the face

• Pain-free intervals between attacks

  
  

Diagnosis and Treatment

Doctors diagnose TN based on symptoms and neurological exams. MRI scans help rule out other causes like tumors or MS.

Treatment options include:

1. Medications to reduce nerve pain

2. Botox injections in some cases

3. Surgical options like microvascular decompression to relieve nerve compression

4. Gamma knife radiosurgery for patients who cannot undergo open surgery

   
   

   2. What is Trigeminal Neuropathy?

Trigeminal neuropathy refers to damage or dysfunction of the trigeminal nerve itself, leading to sensory loss, numbness, or burning pain rather than the sharp attacks seen in neuralgia.

Causes of Trigeminal Neuropathy

Neuropathy can result from:

• Nerve injury due to trauma or surgery

• Infections such as herpes zoster (shingles)

• Diabetes causing nerve damage

• Tumors affecting the nerve

• Inflammatory diseases

  
  

Symptoms of Trigeminal Neuropathy

• Constant burning, tingling, or numbness in the face

• Reduced sensation or altered feeling in the affected area

• Less likely to have sudden, sharp pain attacks

• Possible weakness in muscles controlled by the nerve (if motor branches affected)

  
  

Diagnosis and Treatment

Diagnosis involves clinical examination and imaging to identify nerve damage or underlying causes.

Daniela M. et al, Chronic neuropathic pain is more than a perception: Systems and methods for an integral characterization, Neuroscience & Biobehavioral Reviews, Volume 136, 2022

Treatment of Trigeminal Neuropathic Pain focuses on:

• Managing underlying conditions like diabetes or infections

• Pain relief with medications such as gabapentin or pregabalin

• Physical therapy for muscle weakness

• Sometimes surgical intervention if tumors or structural issues are present

  
  

Why Accurate Diagnosis Matters

TN and TNP require different treatment approaches. What helps one condition may not help the other.

A thorough evaluation usually includes:

• Detailed history of how the pain started

• Mapping the pain distribution

• Sensory testing

• Review of dental and medical history

• Imaging such as MRI when appropriate

Seeing a residency-trained, board-certified Orofacial Pain specialist or a multidisciplinary facial pain provider can significantly improve diagnostic accuracy.

Living with Facial Nerve Pain

Both conditions can severely affect quality of life.

Patients often face challenges such as:

• Difficulty eating or speaking due to pain or numbness

• Emotional distress from chronic pain

• Side effects from medications

  
  

Support from healthcare providers, family, and patient groups can help manage these challenges. Keeping a pain diary and noting triggers or changes can assist doctors in tailoring treatment.

When to See a Doctor

Seek medical advice if you experience:

• Sudden, severe facial pain episodes

• Persistent numbness or tingling in the face

• Weakness in facial muscles

• Pain that worsens or affects daily activities

  
  

Early diagnosis improves treatment outcomes and helps prevent complications.

Advances in Research and Treatment

Researchers continue to explore better treatments for trigeminal nerve disorders. New medications, less invasive surgeries, and nerve stimulation techniques show promise. Several clinical trials are ongoing to find safer, more effective options.

Expert Care for Facial Nerve Pain in Seattle

At Advanced TMJ Maxillofacial Pain & Sleep Center, we specialize in the diagnosis and non-surgical management of complex facial pain conditions, including trigeminal neuralgia and trigeminal neuropathic pain. Our approach is evidence-based, multidisciplinary, and personalized to each patient’s unique condition.

If you’re struggling with unexplained facial pain, you don’t have to navigate it alone.