Severe Facial Pain from Trigeminal Neuralgia in Multiple Sclerosis

Trigeminal Neuralgia or Tic Doloreux and MS

Trigeminal Neuralgia and MS
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Trigeminal neuralgia has to be one of the worst disorders that people with multiple sclerosis (MS) experience. It's one of the types of pain described as “neurogenic pain” or “primary pain,” meaning it's the direct result of the disease process of multiple sclerosis, caused by demyelination and lesions on a specific nerve.

What Does Trigeminal Neuralgia Feel Like?

Trigeminal neuralgia, often called tic doloureux (French for “painful twitch”), is perhaps the most intensely painful MS-related symptom.

It can be described most commonly as:

  • occurring in the lower part of the face (often triggered by talking, chewing, drinking, or brushing one’s teeth)
  • almost always occurs on just one side of the face (and is more common on the right than left side)
  • intense, sharp pain, like an electrical jolt
  • usually the most intense pain is short-lived (from a few seconds to up to two minutes), but can result in a more constant burning or aching

Trigeminal neuralgia can also have the following characteristics:

  • extending as far as the ear, and sometimes mistaken for the pain of an ear infection
  • can be triggered by loud sounds or a cold gust of air

In addition, given the location and nature of the pain associated with trigeminal neuralgia, it's often mistaken for dental pain. This could lead to unnecessary (and irreversible) procedures like tooth extractions, root canals, and even procedures to reposition the jaw.

Make sure that you see your neurologist if you are experiencing this kind of pain, especially before undergoing any kind of drastic dental work.

Finally, each “bout” or episode of trigeminal neuralgia usually lasts a couple of weeks. However, episodes tend to recur and can happen as often as every couple of months, although some people will go years between episodes.

Unfortunately, as time passes, time between bouts generally gets shorter.

How Common Is Trigeminal Neuralgia?

Trigeminal neuralgia is fairly rare, with only 4 person of people with MS experiencing this kind of pain. However, people with MS are 400 times more likely than the general population to have an episode of trigeminal neuralgia. Also, it's interesting to note that trigeminal neuralgia tends to be one of the first symptoms of multiple sclerosis for those who experience it—although, this is not a hard and fast rule.

What Causes Trigeminal Neuralgia?

Trigeminal neuralgia is caused by lesions of the trigeminal nerve, which is also called the fifth cranial nerve. (The 12 cranial nerves emerge directly from the brain instead of from the spinal cord.) The trigeminal nerve controls the muscles needed for chewing, and is responsible for most facial sensation.

How Severe Can Trigeminal Neuralgia Get?

Trigeminal neuralgia can get so severe and distressing that it may require hospitalization and painkillers given through your vein (intravenous).

It can also interfere with a person’s intake of fluids and require that this also be supplemented intravenously. Some people may require surgery for their trigmeinal neuralgia, however this is rare.

Due to the intensity of this disorder, anxiety and fear about the possibility of it recurring can cause significant suffering and interfere with daily life.

The Bottom Line

If you have trigeminal neuralgia from your multiple sclerosis, the good news is that there is an effective medical therapy available. The medication Tegretol (carbamazepine) is an anti-convulsant and has been used for years to treat this disorder.

Reaching out to a support group may also be beneficial for the psychological manifestations of trigeminal neuralgia.  


Krafft RM. Trigeminal neuralgia. Am Fam Physician. 2008;77(9):1291-96.

Turkington, C. and Hooper, K. The A to Z of Multiple Sclerosis. Entry on “trigeminal neuralgia.” New York: Checkmark Books, 2005.

Edited by Dr. Colleen Doherty May 24th 2016.

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