Trigeminal Neuralgia (Tic Doloureux) Facts, Causes, Treatment

This unpleasant condition luckily is rather rare. About 12 new cases per 100,000 people occur each year. Originally called ‘tic doloureux’ for ‘painful spasm,’ the French had it right: this condition causes an excruciating tic, indeed. So what is trigeminal neuralgia (TN)? Let’s investigate this condition that mainly strikes women over age 50.


This condition causes episodes of muscle spasm in the face. These spasms often are extremely painful. The word ‘trigeminal’ refers to one of the cranial nerves — the 5th cranial nerve, to be precise. Every person has 12 pairs of cranial nerves. These nerves control the motor and sensory functions of the eyes, ears, tongue and other areas of the head and face. The cranial nerves extend directly from the brain tissue; other nerves (such as the ones that allow you to move your hands) begin in the spinal cord

The trigeminal nerve is responsible for both facial sensation and for movements such as biting and chewing. Sometimes this nerve becomes irritated, which causes it to spasm. The spasm is painful. Nerve pain is referred to as ‘neuralgia.’ Trigeminal neuralgia, then, is the painful spasm of facial tissue served by the trigeminal nerve


Researchers aren’t exactly sure what causes all cases of TN. They do know some cases may be caused by:

  • A blood vessel that presses on the trigeminal nerve where it exits the brain stem
  • Deterioration of the trigeminal nerve’s coating (called the ‘myelin sheath’) due to multiple sclerosis
  • Compression of the trigeminal nerve by a tumor
  • Compression of the nerve by a ball of tangled arteries and veins
  • Possibly trauma, such as injury to the nerve due to stroke, surgery or accidental trauma


TN is a tricky condition. It symptoms may be sudden and acute, or it may exhibit more subtle signs. The condition may clear up without treatment and remain inactive for a long time, or it may continue for years after the initial onset.In general, TN may manifest with these symptoms:

  • Sudden, painful spasm of the face that lasts for up to two minutes at a time
  • Usually, a visible spasm
  • Stabbing, aching or burning pain of the face, without spasm
  • Facial pain attacks that stop and start
  • Facial pain that goes away during sleep
  • Spasmodic pain triggered by activities such as brushing the teeth or applying makeup


The first treatment for TN usually involves medication. Both anti-seizure drugs and antidepressants may be used. This is not because TN is a seizure disorder or caused by depression. Rather, these medications contain drugs that calm nerves and/or keep them from firing. Surgery is available but is not common for TN. Generally, surgery is reserved for cases where a tumor or arterial tangle is causing the condition. Because living with TN can be depressing and painful, many individuals seek relief in complementary therapies like yoga and meditation. Support groups also may help. Unfortunately, there is no cure for trigeminal neuralgia.


Because researchers haven’t pinpointed what causes TN, it’s impossible to try to prevent it. The main risk factors are age (being older than 50) and sex (being female). Neither of these risk factors can be controlled.


You may need to try several types of treatment to find relief for your TN. Often the condition goes away abruptly — sometimes for years at a time. During periods of activity, you may want to try therapies that calm and soothe you, generally, to help cope with the painful facial spasms of trigeminal neuralgia. Psychotherapy and support groups also may help you live with this uncomfortable condition.