Rare Symptoms of MS: 12 Things to Know About Trigeminal Neuralgia

Trigeminal neuralgia is a term used for facial pain associated with damage to the trigeminal nerve, or the 5th cranial nerve — the largest one among the body’s 12 pairs of cranial nerves and one of the most widely distributed nerves in the head.

Usually occurring in people older than 50, trigeminal neuralgia affects women more than men. The condition is more common among people with multiple sclerosis (MS) than in the general population.

A list of 12 facts about trigeminal neuralgia, described here, provide further information about this rare MS symptom:

• There are two trigeminal nerves, one on each side of the face. Each nerve has three main branches: the upper or ophthalmic branch, which reaches to most of the scalp, forehead, and front of the head; the middle or maxillary branch that stimulates the nose, cheeks and upper jaw, top lip, teeth, and gums; and the lower or mandibular branch, which reaches the lower jaw and bottom lip, as well as the teeth and gums.
• Damage to the myelin sheath or protective coating shielding the trigeminal nerve is what causes pain in MS. Having a blood vessel pressing on the nerve inside the skull also can result in trigeminal neuralgia and has been occasionally reported in MS patients.
• Trigeminal nerve pain may be triggered by everyday activities such as eating, brushing teeth, washing the face, talking, head movements, air conditioning, breeze/wind exposure, or hot or cold food. It also may come up spontaneously without a trigger.
• Pain can last for a few seconds to up to a few minutes. For some, pain is constant.
• Some report pain like an electric shock, whereas others report an aching or burning sensation.
• Trigeminal neuralgia usually only affects one side of the face, but in rare cases, both sides can be affected at different times.
• Pain can range from mild to excruciating.
• Trigeminal neuralgia can sometimes be mistaken for dental pain or eye pain; thus one should visit a healthcare specialist to determine if the pain is a symptom of MS before considering dental or eye procedures.
• Over-the-counter pain medications — such as paracetamol, aspirin, or ibuprofen — are not effective treatments for trigeminal neuralgia pain.
• The condition often is treated initially with carbamazepine, an anticonvulsant or anti-epileptic medicine that can be used for nerve pain. The muscle relaxant Baclofen also may be given to help relax the muscles.
• If medication is ineffective or causes significant side effects, surgery may be required to deliberately injure the trigeminal nerve so that it stops sending pain signals.
• It is estimated that 4–6% of people with MS experience trigeminal neuralgia.

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