Trigeminal neuralgia produces sudden attacks of severe facial pain, usually on one side, described as shock-like or stabbing. Individual attacks typically last only a few seconds, though they can last up to two minutes, and they may repeat many times a day.1 That pattern — extreme intensity, extremely short duration, triggered by ordinary touch — is what separates it from most other facial pain, and it is why the condition is so often mistaken for a dental problem first.
Which nerve, and which part of the face
The trigeminal nerves are a pair of cranial nerves connecting the brain and brain stem to different parts of the face. Each has three branches carrying sensation from the upper, middle and lower portions of the face: the ophthalmic branch supplies most of the scalp, forehead and front of the head, and the maxillary branch supplies the cheek, upper jaw, top lip and teeth.1
Because the maxillary branch serves the upper teeth, pain in that distribution can be indistinguishable from toothache to the person experiencing it. Dental work that does not resolve the pain is a common part of the history.
What sets off an attack
Attacks can be triggered by vibration or contact with the cheek — shaving, washing the face, applying makeup — and by teeth brushing, nose blowing, eating, drinking, talking, or exposure to wind.1 The pain rarely occurs during sleep.1
This is worth stating plainly to family members, because the triggers look trivial from outside. Avoiding a breeze or declining to eat in company is not avoidance behavior; it is a rational response to something that reliably causes severe pain.
It can progress
Pain may stop for a period and then return. In some cases the condition is progressive, with attacks becoming longer and more frequent over time, and in progressive trigeminal neuralgia a person may feel pain constantly.1 Early evaluation matters for that reason.
Why it happens
In the classic form — the most common — a blood vessel, usually the superior cerebellar artery, is found to be pushing on part of the trigeminal nerve root.1
Secondary trigeminal neuralgia is caused by another disorder such as multiple sclerosis, a tumor, or an arteriovenous malformation. People with secondary trigeminal neuralgia are more likely to be younger and to have pain on both sides of the face, and only 15% of cases are secondary.1 When no cause is found after a diagnostic workup it is called idiopathic, which is the least common type.1
Bilateral facial pain in a younger person is therefore a finding that changes the workup rather than a detail to note in passing.
How it is treated, and one thing that does not work
Anticonvulsant medicines, used to block pain signals, can reduce attack frequency; these include carbamazepine, oxcarbazepine, gabapentin, pregabalin, lamotrigine, topiramate and phenytoin, and more than one may be used together if a single drug fails. Baclofen and botulinum toxin A may be tried when anticonvulsants are ineffective or side effects are troublesome.1 Choice and dosing are decisions for the treating physician.
Notably, common pain-relieving medications such as aspirin and ibuprofen, and opioid medications such as hydrocodone, are not usually helpful in treating trigeminal neuralgia.1 That is a useful fact for anyone who has been cycled through analgesics without benefit and concluded the pain must be imagined. It is not — this pain simply does not respond to that class of drug.
Where facial and head pain is being evaluated, the practice’s approach to severe head and neck pain and to targeted nerve blocks is described on those pages.
Frequently asked questions
How long does a trigeminal neuralgia attack last?
Typically only a few seconds, though attacks can last up to two minutes and may recur many times a day. The very short duration combined with severe intensity is characteristic. Related facial and head pain evaluation is described under severe head and neck pain.
Why does my face hurt when I brush my teeth or feel a breeze?
Light touch and vibration are recognized triggers, along with shaving, washing the face, eating, drinking, talking and wind. This is a feature of the condition rather than sensitivity or imagination. See the range of pain treatments for how facial pain is approached.
Could this be something other than trigeminal neuralgia?
Possibly. Pain on both sides of the face, or onset at a younger age, raises the likelihood of a secondary cause such as multiple sclerosis or a tumor, which accounts for about 15% of cases and changes the workup. Evaluation options are outlined on the pain management doctors in St. Louis page.
Will painkillers help?
Usually not. Aspirin, ibuprofen and opioids such as hydrocodone are not typically effective for this condition, which is one reason treatment focuses elsewhere. How the practice approaches medication burden generally is described under opioid stewardship.
Does it get worse if left alone?
It can. Pain may remit and return, and in progressive cases attacks become longer and more frequent, sometimes becoming constant. That argues for evaluation rather than waiting, which you can arrange through the appointment request form.
To have facial pain evaluated, request an appointment, call (314) 481-5000, or text (314) 886-5902.
Sources
- National Institute of Neurological Disorders and Stroke. Trigeminal Neuralgia. National Institutes of Health. Accessed August 12, 2026. NINDS — Trigeminal Neuralgia
Dr. Gurpreet Singh Padda, MD, MBA, MHP
