What Triggers a Trigeminal Neuralgia Attack?

If there’s one thing that characterizes trigeminal neuralgia, it’s pain. As you are learning more about your condition, you wonder why it is so painful and what triggers a trigeminal neuralgia attack. Though all patients are different, it can be helpful to understand a little more about the underlying cause of trigeminal neuralgia and some of the common triggers that could bring on an episode.

About Trigeminal Neuralgia

The first step in understanding what triggers a trigeminal neuralgia attack is to explain the cause of the condition. The trigeminal nerve is the cranial nerve that transmits sensory information from the face to the brain. Cranial nerves are paired, which means there is one going to each side of the body. The trigeminal nerve has three branches, and each supplies the nerves to a different section of the face: the top third, middle third and bottom third.

In trigeminal neuralgia, something causes the trigeminal nerve to misfire and send inappropriate pain signals to the brain. The most common cause is a small blood vessel in the brain pressing on the nerve. Occasionally, a tumor is the culprit. Some patients with multiple sclerosis can also develop trigeminal neuralgia as the nerve loses its protective covering (myelin sheath). Though rare, sometimes there is no obvious underlying cause.

Trigeminal Neuralgia Symptoms

There’s really only one symptom of trigeminal neuralgia, and that’s pain. However, the pain typically follows a particular pattern that can help your doctor form a diagnosis. Symptoms of trigeminal neuralgia include:

  • Pain in one side of the face
  • Pain that can be debilitating
  • Pain that lasts for seconds or minutes
  • Pain that is described as electric or stabbing
  • Pain that is triggered by activities that should not elicit a pain response
  • Pain that occurs during “attacks,” which often increase in frequency and duration over time
  • Some patients experience numbness, tingling or dull ache before the onset of an attack


Unfortunately, 100% of patients who have trigeminal neuralgia will experience symptoms. This is because the pain essentially is the condition. There are no diagnostic tests, like x-rays or blood work, that can be done to diagnose trigeminal neuralgia. Instead, your doctor will evaluate your symptoms and rule out other potential causes of your pain to arrive at a diagnosis.

What Triggers Trigeminal Neuralgia Attacks?

There are many potential triggers of trigeminal neuralgia pain. During an attack, otherwise “normal” activities can trigger sharp pain. This is because the brain is receiving sensory signals along the trigeminal nerve but misinterpreting them as painful. Triggers include:

  • Hot or cold liquids and foods
  • Talking
  • Brushing your teeth
  • Gentle touch on your face
  • Smiling and laughing
  • Wind or a hair dryer blowing on your face
  • Shaving
  • Washing your face
  • Applying makeup


What triggers your trigeminal neuralgia pain may not be the same as the next person. Some people can feel an “aura” – tingling, numbness or a dull pain – before the attack is triggered. Rarely, some patients experience constant pain rather than attacks. This is called atypical trigeminal neuralgia because it’s uncommon and varies from the typical patient experience.

Relieving Trigeminal Neuralgia Pain

The first step in treating trigeminal neuralgia is often medications, like anti-seizure, antidepressants, and muscle relaxers. However, the effectiveness tends to diminish over time, and some patients no longer respond to medications after long-term use.

Another approach is to treat the cause of your trigeminal neuralgia. Recall that the culprit is typically a deviating blood vessel impinging on the trigeminal nerve. There are two common methods to alleviate the problem: surgery and Gamma Knife radiosurgery.

If your doctor recommends trigeminal neuralgia surgery, it will take place in a hospital while you are asleep and comfortable. Your neurosurgeon will go in and physically remove or relocate the offending structure. Most patients spend up to a week recovering in the hospital, followed by 4-6 weeks recovering at home.

A second treatment option is Gamma Knife radiosurgery. Despite the name, the procedure is a minimally invasive process without any surgery or incisions. Rather, it’s an advanced form of radiation therapy that can treat the source of your pain. There is no hospital stay and no lengthy recovery. In fact, most patients are back to normal daily activities within a day or two. Gamma Knife radiosurgery can be an excellent treatment option for patients who cannot undergo surgery, have already had surgery without results or who simply prefer a minimally invasive treatment option.

Your Individual Experience

It’s important to remember that your experience is going to be different from another patient’s. The things that trigger your attacks, the quality and duration of your pain and what treatment works for you is going to be a very personal thing. This is part of what has historically made trigeminal neuralgia difficult to manage.

But don’t lose hope. Thanks to clinicians and researchers, more is known than ever about diagnosing and treating trigeminal neuralgia. Work with your doctor to find a trigeminal neuralgia expert who can help you understand your symptoms and develop a treatment plan that is right for you.

As you move forward through the process, continue to educate yourself about your condition and treatment options. Write down any questions you have and bring them to your next appointment. Your doctor is there to help explain the process and help you feel confident with all aspects of your care.

Anthony D’Ambrosio, M.D., M.B.A., F.A.A.N.S
Anthony D’Ambrosio, M.D., M.B.A., F.A.A.N.S
Dr. Anthony D’Ambrosio is a board-certified neurosurgeon that specializes in Neurosurgery, Stereotactic Radiosurgery, Gamma Knife Radiosurgery (GKRS) and more. He is the Director of Neurosurgery and Co-Director of the Gamma Knife Program at The Valley Hospital. Dr. D’Ambrosio is an expert in treating patients with trigeminal neuralgia, benign or malignant brain tumors, as well as many other neurological conditions.

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