Burning, stabbing, lightning-like pain in your face? Maybe constant facial aching? A few seconds to a few minutes of exquisitely agonizing pain beyond imagining? It’s very possible you’re experiencing what’s commonly called tic douloureux. More technically, the condition is trigeminal neuralgia, or TN. At best, TN can be annoying, and at worst, it can be completely debilitating.

TN pain can be so bad that you consider ending it all, the reason it’s called the suicide disease.

A variety of things can bring on a TN episode. It could be as simple as touching some place on your face, shaving, brushing your teeth, applying cosmetics and many other apparently innocuous activities.

There’s little comfort in knowing that many people suffer TN. Estimates vary, but some say there are as many as 150,000 new cases each year.

What’s happening in your body

The trigeminal nerve is the fifth major nerve that starts in your brainstem, cranial nerve V, and the most widely distributed nerve in your head. While it’s treated as a single nerve, it is actually three pairs of nerves. Those three branches innervate the upper, middle and lower parts of your face, as well as your oral cavity. Along with the vagus nerve, the trigeminal nerve also innervates your meninges, the three layers of tissue that cover your brain, and are the only parts of your brain that can experience pain.

In addition to being central in TN, the trigeminal nerve is implicated in migraine headaches. (See my column from Aug. 17, 2018, “With migraines, identifying the cause is key.”)

What’s happening with TN is that the trigeminal nerve is being inflamed, being compromised in some way. It could be a blood vessel pressing on it as it emerges from your brainstem. Over time, this results in the nerve’s protective coating, myelin sheath, being eroded. Not surprisingly, people with multiple sclerosis frequently experience TN because the action of MS is progressively to destroy the myelin sheath from many nerves.

There may be injury to the trigeminal nerve resulting from sinus or oral surgery, a stroke or perhaps some trauma to your face. A tumor, burns and allergic reactions are implicated, as well.

Is it really TN?

There are many conditions that can cause facial pain, and it’s important to have a clear medical diagnosis. Typically, this will include an MRI, and possibly a short course of an anti-seizure medication. Possibilities other than TN include things like TMJ, cluster headaches and neuralgia (nerve pain) following an episode of shingles.

Treating TN

The good news is that remission of TN frequently happens spontaneously. The bad news is that medical treatments for TN, while often effective, have some pretty undesirable downsides.

The most common first treatment includes anti-convulsive and antidepressant drugs. These drugs may be effective early on, but they tend to lose their effectiveness and leave you with TN pain, as well as side effects from the drugs. The side effects are commonly disturbance of your thinking functions, loss of memory, fatigue and even suppression of your bone marrow. That is, the drugs that help with TN also act to suppress your bone marrow’s production of the cells you need critically to provide immunity (leukocytes), to carry oxygen around your body (erythrocytes) and to clot your blood when necessary (thrombocytes).

NSAIDs and opioids seem not to be particularly effective against TN.


There is an amazing assortment of surgical procedures that can be performed. With many of these, it’s likely you will have some degree of numbness in your face, and, even if successful, the TN may return. Other risks of surgery include problems with your balance, loss of hearing, spinal fluid leakage, infection, and a combination of deep burning pain and facial numbness. I think surgery really should be the last thing you try.

Do-it-yourself remedies

TN sufferers have tried a variety of self-help techniques. Different ones seem to help in different cases. Examples are applying gentle heat or cold to your face, or applying pressure to the painful area. While light touch may set off an episode, heavier pressure sometimes decreases the pain.

You might try a cream made by mixing some cayenne pepper into a bit of olive oil. But be careful with this, as the capsaicin in cayenne can be irritating to sensitive skin. You can try the same with an assortment of Chinese herbs. Homeopathic Spigelia has been used, as well.

One of the few proven treatments is CBD oil. It is well-known now to be effective against a variety of inflammatory conditions. One milliliter of CBD oil a day can prevent future attacks, as well.

Good treatments?

The good news is that many are finding help from complementary treatments. For examples, yoga, aromatherapy and meditation have helped some. Others include acupuncture, chiropractic and nutritional therapies. And some have found Botox injections to be helpful. Unfortunately, there is no credible research on the effect of these approaches, but they may be worth trying before drugs or surgery.

In addition, of course, and closest to my heart, are myokinesthetic (MYK) treatments. The same treatment I have used effectively for migraine headaches can help modulate the pain of trigeminal neuralgia. Depending on the cause, and like migraine remission, these treatments may correct the problem at its base.

Bob Keller maintains a holistic practice in Newburyport. He offers medical massage therapy for pain relief, as well as psychological counseling, dream work and spiritual direction. Many patients call him Dr. Bob and accuse him of doing miracles, but he is not a medical doctor nor a divinity. His expertise is medical massage therapy, understanding this miracle we call the human being. He can be reached at 978-465-5111 or rk2name@gmail.com

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