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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Partly. A doctor can recognise trigeminal neuralgia by video and start or review treatment; blood tests, an MRI scan, specialist medicines and surgery are in person.
- What it is: sudden, severe, electric-shock pain on one side of the face, from the trigeminal nerve, which carries feeling from the face, teeth and mouth to the brain.
- How long attacks last: a few seconds to about 2 minutes, in bouts lasting days, weeks or months. In severe cases there can be hundreds a day.
- Who gets it: 0.16 to 0.3% of people at some point in their lives. It usually starts between the ages of 50 and 60, and is more common in women.
- Emergency: call 112 for facial pain with weakness or drooping of the face, slurred speech, loss of vision, or a sudden, severe headache, and for a blistering rash on carbamazepine.
Do not book a video appointment if facial pain comes with weakness or drooping of the face, slurred speech, loss of vision, confusion or a sudden, severe headache, or if you develop a painful rash with blisters, mouth ulcers or difficulty breathing while taking carbamazepine. Call 112 or go to an emergency department.
Can an online doctor treat trigeminal neuralgia?
Partly. There is no specific test for trigeminal neuralgia: it is diagnosed from your description of the pain, which a doctor can take by video. The doctor can rule out look-alikes, check for signs of another cause, and start or review carbamazepine when it is safe for you, with blood tests arranged in person. An MRI scan, specialist medicines when carbamazepine does not suit you, and surgery are in person.
How an online consultation helps with trigeminal neuralgia
- Facial pain sorted out: Dental pain, jaw joint problems, cluster headache and nerve pain after shingles can feel similar, and the pattern tells them apart.
- Red flags checked: Pain on both sides, attacks longer than 2 minutes, constant pain or a younger age point to another cause and an MRI scan.
- Treatment that is safe for you: Carbamazepine started slowly, with the checks it needs for blood tests, contraception, pregnancy and your other medicines.
- A route to specialists: When carbamazepine stops working or does not suit you, the doctor explains the next medicines and the surgical options.
What the doctor checks in an online trigeminal neuralgia consultation
The doctor asks about the warning signs first, then about the pain. The doctor asks about:
- Warning signs: weakness or drooping of the face, slurred speech, loss of vision, hearing loss, or a sudden, severe headache.
- The pain: what it feels like, how long each attack lasts, how many come in a day, and which part of the face it affects.
- Triggers: touching the face, washing, shaving, brushing teeth, eating, talking, a breeze or air conditioning.
- Between attacks: whether the pain stops completely, or a constant ache or burning remains.
- Your teeth: whether a dentist has checked for a dental cause, and any recent dental work.
- Your health: multiple sclerosis, shingles on the face, high blood pressure, migraine, liver or kidney problems, glaucoma, pregnancy or plans for it, contraception, all your medicines, and Han Chinese family background, which changes the checks before carbamazepine.
Before the call, write down when the attacks started, what sets them off, and what you have tried. A dental check first is worth it if the pain is in your teeth or gums.
What is trigeminal neuralgia, and what causes it?
Trigeminal neuralgia is a long-term nerve pain condition that causes sudden, severe facial pain, usually felt as a sharp, shooting pain or an electric shock in the jaw, teeth or gums. It is also called tic douloureux. The trigeminal nerve has three branches: the upper one supplies the forehead and scalp, the middle one the cheek, upper jaw, upper lip and teeth, and the lower one the lower jaw, lower lip and teeth. The middle and lower branches are most often affected.
What causes trigeminal neuralgia to start?
Doctors divide it into three types by cause:
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| Type | Cause | Share of cases |
|---|---|---|
| Classical | A blood vessel at the base of the brain presses on the trigeminal nerve | About 75% |
| Secondary | Another condition damages the nerve, such as multiple sclerosis or a tumour; people tend to be younger, and pain on both sides is more common | About 15% |
| Idiopathic | No cause is found after tests | About 10% |
How common is it, and who gets it?
Between 0.16 and 0.3% of people have trigeminal neuralgia at some point in their lives, and each year 4 to 29 people in every 100,000 develop it. It affects women more than men, in a ratio of about 3 to 2. It usually starts between the ages of 50 and 60, on average at 53 to 57, and is rare in adults under 40. Multiple sclerosis and high blood pressure are known risk factors, and a history of migraine may raise the risk.
What does trigeminal neuralgia feel like?
The main symptom is a sudden attack of severe pain on one side of the face, like an electric shock, that stops as suddenly as it started. Typically:
- each attack lasts from a few seconds to about 2 minutes
- attacks come in bouts lasting days, weeks or months, and in severe cases hundreds of times a day
- the pain is usually on one side, most often the lower face; the right side is affected in about 60% of people
- the pain rarely comes during sleep
- the pain may ease or disappear for months or years (remission), but remissions tend to get shorter over time
Between 14 and 50% of people also have a constant aching, throbbing or burning pain between the sharp attacks. The condition can affect quality of life badly, leading to weight loss, isolation and depression.
What triggers trigeminal neuralgia?
Attacks are usually set off by light touch or movement of the face:
- washing the face, shaving or putting on make-up
- brushing your teeth
- eating, chewing, drinking, talking or smiling
- wind, a slight breeze or air conditioning
- moving your face or head
Sometimes attacks come with no clear trigger. Eating and drinking set attacks off through the movement and touch on the face and mouth.
What can be mistaken for trigeminal neuralgia?
Several conditions cause similar pain, which is why diagnosis can take time. Many people see a dentist first:
Swipe sideways to compare →
| Condition | How it differs | What to do |
|---|---|---|
| Trigeminal neuralgia | Electric-shock attacks of seconds to 2 minutes, set off by light touch, on one side | See a doctor; usually starts with carbamazepine |
| A dental problem | Pain from an infected or cracked tooth, found on examination or an X-ray | See a dentist |
| Jaw joint problems (temporomandibular disorder) | Constant or long-lasting pain around the jaw, often on both sides | A dentist or doctor |
| Cluster headache | Attacks lasting 15 to 180 minutes around one eye, with a red, watering eye and restlessness | See a doctor |
| Post-herpetic neuralgia | Nerve pain in an area where shingles has been | See a doctor |
| Migraine | A throbbing headache lasting hours, often with feeling sick and sensitivity to light | See a doctor |
| Other short nerve-pain headaches | Attacks lasting longer than 2 minutes | A specialist assessment |
What are the red flags for trigeminal neuralgia?
These features point to another cause, or to secondary trigeminal neuralgia, and need an MRI scan and a specialist:
- attacks on both sides at once, or switching sides
- attacks lasting longer than 2 minutes
- constant pain on both sides, or no attacks that can be triggered at all
- a younger age: trigeminal neuralgia is rare under 40
- known multiple sclerosis or a tumour
How is trigeminal neuralgia diagnosed?
There is no specific test. Diagnosis rests on how often the attacks come, how long they last, which parts of the face they affect and what sets them off, together with the rest of your health history. A dentist may first take an X-ray to rule out a dental cause.
An MRI scan is often used. It is the best test for ruling out a secondary cause, such as multiple sclerosis or a tumour, and it can show whether a blood vessel is pressing on the nerve. Confirming the diagnosis can take time, sometimes years.
Which trigeminal neuralgia treatment might the doctor recommend?
Treatment depends on whether the pattern is typical, whether there are red flags, and how you respond to carbamazepine. This is the framework the doctors use:
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| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| Typical attacks, no red flags, a dental cause ruled out | Carbamazepine, started slowly | Yes | For blood tests, and an MRI scan |
| Pain in the teeth or gums, not yet checked by a dentist | A dental examination first | Partly | At a dentist |
| Red flags: both sides, longer attacks, constant pain, under 40 | An MRI scan and a specialist | Partly | For the scan and a neurologist |
| Carbamazepine not working or causing side effects | Oxcarbazepine or a specialist medicine | Partly | A specialist for second-line medicines |
| Pain no longer controlled by medicines | Assessment for a procedure or surgery | Partly | A neurosurgeon or pain specialist |
| In remission | Reducing carbamazepine slowly over weeks | Yes | Not usually needed |
| Facial pain with weakness, slurred speech, loss of vision or a sudden, severe headache | Emergency care | No | Call 112 now |
Sudden, shock-like pain in your face? A doctor can tell you in one consultation whether it fits trigeminal neuralgia and what to do next.
See available times →Treatment options for trigeminal neuralgia
What you can do yourself
- Keep a diary of attacks and triggers, to share with the doctor.
- Protect your face from wind and air conditioning, and notice which daily tasks set off attacks.
- Take your treatment regularly, not only during attacks.
- Do not change the dose or stop suddenly: changes are made gradually, over days or weeks.
- Avoid grapefruit and grapefruit juice with carbamazepine, and go easy on alcohol.
- Do not drive if the treatment makes you tired, dizzy or unsteady.
Prescription treatment
A prescription is never issued without a consultation. Carbamazepine is the usual first treatment and the only medicine licensed for trigeminal neuralgia in the UK. It is an anticonvulsant that slows the electrical impulses in nerves. It is started at a low dose and increased gradually, and taken regularly, often for many years. Almost 90% of people get pain control at first, although this may not last, and side effects make up to 40% stop. Common side effects are tiredness, dizziness, unsteadiness, double vision and feeling sick, and it can lower sodium and white blood cells, which is why blood tests are needed. Before starting, people of Han Chinese background need a genetic test for a rare serious skin reaction. It can stop hormonal contraception working, and it carries risks in pregnancy. Oxcarbazepine is an alternative first choice. If you are prescribed carbamazepine, the doctor arranges the blood tests in person. Other medicines, such as lamotrigine, baclofen or botulinum toxin, are started by specialists, and gabapentin and pregabalin are controlled medicines that are never prescribed online. Opioid painkillers do not usually help this pain, and are never prescribed online. If the doctor prescribes, use the prescription at a pharmacy near you.
Why ordinary painkillers do not work
This is nerve pain, and paracetamol is not effective for it. Aspirin, ibuprofen and opioid painkillers are usually not helpful either, which is why treatment uses medicines that calm the nerve.
Procedures and surgery
If medicines do not control the pain or cause troublesome side effects, a specialist can discuss a procedure:
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| Procedure | What it does | How well it works | Main side effects |
|---|---|---|---|
| Microvascular decompression | An operation that moves the blood vessel off the nerve | 62 to 89% pain-free 3 to 10 years later; the longest-lasting relief | Facial numbness, hearing loss, rarely stroke; risk of death 0.3% |
| Balloon compression, glycerol injection, radiofrequency lesioning | A needle through the cheek damages the nerve on purpose | 19 to 82% pain-free, depending on the method; relief lasts about 3 to 4 years on average | Facial numbness in 15 to 40% |
| Stereotactic radiosurgery | A focused radiation beam on the nerve, without cuts | 30 to 66% pain-free after 3 to 5 years; can take up to 6 months to work | Facial numbness or pins and needles in about 16% |
What does not help
Paracetamol, ibuprofen and opioid painkillers. Taking carbamazepine only when attacks come. Stopping it suddenly. Repeated dental treatment once a dentist has ruled out a dental cause.
Does trigeminal neuralgia go away? Can it kill you?
It is usually a long-term condition, but treatment helps most people to some degree. Remissions are common, though they tend to get shorter over time, and the condition can progress, with longer and more frequent attacks and medicines working less well. Microvascular decompression is the closest thing to a cure: some studies suggest the pain comes back in about 3 in 10 people within 10 to 20 years.
Trigeminal neuralgia is not life-threatening, but it can be life-altering. The dangers lie around it: severe pain can lead to weight loss, isolation, anxiety and depression, carbamazepine has rare but serious side effects, and surgery carries small risks. If the pain is affecting your mood, tell the doctor, and if you have thoughts of harming yourself, call 112 or go to an emergency department. The Trigeminal Neuralgia Association UK offers support.
Special situations
Pregnancy and contraception
Carbamazepine is linked with an increased risk of problems for the baby, and it is usually advised in pregnancy only when the benefits outweigh the risks. Contact the doctor straight away if you become pregnant or are planning a pregnancy. Some contraceptives, such as the pill, the patch and the implant, may not work well with carbamazepine.
Multiple sclerosis
Trigeminal neuralgia can be caused by multiple sclerosis, but it is very unlikely to be its first symptom.
Older adults
Dizziness, unsteadiness and confusion are possible side effects of carbamazepine, so the dose is increased slowly and checked.
Trigeminal neuralgia while travelling in Europe
Wind and air conditioning are common triggers, so cover your face outdoors and avoid sitting in a draught. Pack enough medicine for the whole trip in your hand luggage, because stopping suddenly is not safe.
Children
Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When trigeminal neuralgia is treated online, and when you need in-person care
Treated online: recognising trigeminal neuralgia from the pattern of attacks, ruling out look-alikes, starting and adjusting carbamazepine, reducing it in remission, managing side effects, and follow-up.
In-person care: a dental examination, blood tests, an MRI scan, red flags such as pain on both sides or a younger age, specialist medicines, procedures and surgery, and any emergency sign.
When to get in-person care
Call 112 or go to an emergency department now for:
- facial pain with weakness or drooping of the face, slurred speech, or numbness or weakness in an arm or a leg
- loss of vision, drowsiness or confusion, or a seizure
- a sudden, severe headache that reaches its worst within 5 minutes
- a headache after a head injury, or with a high temperature and a stiff neck
- a painful rash with blisters, mouth ulcers or difficulty breathing while taking carbamazepine
- thoughts of harming yourself
Get medical advice the same day for:
- new facial pain with jaw pain when eating, a sore scalp, or blurred or double vision
- yellowing of the skin or eyes while taking carbamazepine
- becoming pregnant while taking carbamazepine
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about the pain: describe what an attack feels like, how long it lasts, where it is and what sets it off, and list your medicines and any dental checks.
- Leave with a plan: what to do, what to take and for how long, and which signs mean you should be seen in person. If the doctor prescribes, use the prescription at a pharmacy near you.
No sign-up needed
Not sure it’s trigeminal neuralgia? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
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Similar symptoms, different condition? Cluster headaches can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about trigeminal neuralgia
What is trigeminal neuralgia?
A long-term nerve pain condition that causes sudden, severe, electric-shock pain on one side of the face, usually in the jaw, teeth or gums. It comes from the trigeminal nerve, which carries feeling from the face to the brain.
What does trigeminal neuralgia feel like?
Trigeminal neuralgia feels like a sharp, shooting or electric-shock pain that lasts from a few seconds to about 2 minutes and stops as suddenly as it started. Attacks come in bouts, sometimes many times a day, and some people also have a constant ache or burning between them.
What causes trigeminal neuralgia to start?
Most often a blood vessel at the base of the brain pressing on the trigeminal nerve, which causes about 75% of cases. About 15% are caused by another condition, such as multiple sclerosis or a tumour, and in about 10% no cause is found.
What can be mistaken for trigeminal neuralgia?
Dental problems such as an infected or cracked tooth, jaw joint problems, cluster headache, nerve pain after shingles, and other short nerve-pain headaches. A dentist and a doctor can tell them apart from trigeminal neuralgia, sometimes with an MRI scan.
What are the red flags for trigeminal neuralgia?
Red flags in trigeminal neuralgia are attacks on both sides, attacks lasting longer than 2 minutes, constant pain without attacks, starting before the age of 40, and known multiple sclerosis or a tumour. These need an MRI scan and a specialist.
What is the best treatment for trigeminal neuralgia?
Carbamazepine is the usual first treatment for trigeminal neuralgia, and almost 90% of people get pain control at first. If it stops working or causes side effects, specialists can offer other medicines, procedures or an operation called microvascular decompression, which gives the longest-lasting relief.
Can trigeminal neuralgia attacks be prevented?
The condition cannot be prevented, but attacks can be made far rarer: take the prescribed medicine on a regular schedule rather than waiting for pain, learn your triggers and work around them, with soft food, lukewarm drinks, a soft toothbrush and a scarf against wind, use a straw if drinking sets it off, keep stress and tiredness down, and ask for a dose review early if attacks are creeping back, because trigeminal neuralgia tends to need adjustments over the years.
What foods trigger trigeminal neuralgia?
Eating, chewing and drinking are common triggers of trigeminal neuralgia, through the movement and touch on the face and mouth. Washing the face, brushing teeth, talking, smiling and a light breeze are other common triggers.
How can I calm a trigeminal neuralgia attack at home?
Ordinary painkillers do not usually help trigeminal neuralgia. Taking your prescribed treatment regularly, rather than only during attacks, prevents them best. Protecting your face from wind and air conditioning and noting your triggers can reduce attacks.
Can trigeminal neuralgia kill you?
No, trigeminal neuralgia is not life-threatening, but it can be life-altering. Severe pain can lead to weight loss, isolation and depression, so tell a doctor if it affects your mood, and call 112 if you have thoughts of harming yourself.
Does trigeminal neuralgia go away?
Trigeminal neuralgia can ease for months or years, but remissions tend to get shorter over time, and it is usually long-term. Microvascular decompression is the closest thing to a cure, although the pain comes back in about 3 in 10 people within 10 to 20 years.
Can an online doctor treat trigeminal neuralgia?
Partly. A doctor can recognise trigeminal neuralgia from your description by video, rule out look-alikes and start or review carbamazepine. Blood tests, an MRI scan, specialist medicines and surgery are in person.
- Trigeminal neuralgia, NHS, National Health Service (UK), reviewed 27 January 2023.
- Trigeminal neuralgia: diagnosis, NHS, National Health Service (UK), reviewed 27 January 2023.
- Trigeminal neuralgia: treatment, NHS, National Health Service (UK), reviewed 27 January 2023.
- Trigeminal neuralgia: a practical guide, Lambru G, Zakrzewska J, Matharu M. Practical Neurology, 2021.
- Trigeminal neuralgia, NINDS, US National Institute of Neurological Disorders and Stroke, reviewed 13 March 2026.
- Trigeminal neuralgia: symptoms and causes, Mayo Clinic (US), updated 3 July 2026.
- Carbamazepine, NHS, National Health Service (UK), reviewed 6 August 2026.
- Trigeminal neuralgia, Cleveland Clinic (US), reviewed June 2024.
- Cluster headaches, NHS, National Health Service (UK), reviewed 18 August 2023.
- Headaches, NHS, National Health Service (UK), reviewed 17 April 2024.
- Headaches in over 12s: diagnosis and management (CG150), NICE, National Institute for Health and Care Excellence, 2012, updated 2021.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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