Trigeminal neuralgia and shingles show how neuralgia causes nerve pain

Trigeminal neuralgia causes sudden electric shock pain in the face

Trigeminal neuralgia is sudden, severe facial pain. People often describe it as a sharp shooting pain or an electric shock in the jaw, teeth or gums ^[1].

• Attacks last from a few seconds to about 2 minutes and stop as suddenly as they start ^[1].
• The pain usually affects one side of the face, most often the lower part ^[1].
• Light touch can bring it on, such as washing, eating or brushing teeth. Wind, air conditioning and movement of the face or head can too ^[1].
• Sometimes the pain comes with no trigger at all ^[1].
• Some people later develop a constant aching, throbbing or burning feeling, sometimes along with the sharp attacks ^[1].

The condition is thought to be rare. It affects more women than men and usually starts between ages 50 and 60 ^[1]. Pain on both sides, marked numbness, constant pain or attacks with no trigger should lead doctors to look for another cause ^[3].

A nearby blood vessel usually compresses the trigeminal nerve

The trigeminal nerve runs inside the skull and carries touch and pain from your face, teeth and mouth to your brain ^[1]. A nearby blood vessel pressing on part of this nerve is the usual cause of the condition ^[1].

Another medical condition can also damage the nerve. Multiple sclerosis and a space-occupying lesion, meaning a growth that takes up room, are examples ^[4]. Doctors sort the condition into classical (blood vessel pressure with changes in the nerve), secondary (caused by another disease) and idiopathic (no cause found) ^[4][3]. High-resolution MRI helps show structural problems and blood vessel pressure ^[3].

Diagnosis can be hard and may take a few years to confirm ^[1]. Frequent or persistent facial pain deserves a doctor's visit, especially when standard painkillers do not help and a dentist has ruled out dental causes ^[1].

Researchers are also studying whether oxidative stress, a type of chemical damage to cells, adds to the problem. This work is still experimental and has not produced established treatments ^[4].

Shingles can cause nerve pain on one side of the trunk or face

Shingles is an infection that causes a painful rash. The chickenpox virus causes it, and the virus can wake up later if the immune system is weakened ^[2].

• Tingling or pain in an area of skin comes first. A rash usually appears a few days later, though rarely there is pain without a rash ^[2].
• The rash appears on one side of the body only. It usually shows on the chest and belly but can appear on the face, eyes and genitals ^[2].
• Blotches turn into itchy, oozing blisters that dry out and scab a few days later ^[2].
• The rash can take up to 4 weeks to heal. The skin can stay painful for weeks afterward but usually improves ^[2].
• In some people, pain lasts for several months after the rash has gone ^[2].

Treatment works best when it starts within 3 days of the rash appearing. It may speed recovery and avoid longer-lasting problems ^[2]. Treatment can also include pain relievers, steroid tablets or medicines for nerve pain ^[2]. Vaccination lowers the risk of shingles, and symptoms can be much milder if you get it anyway ^[2].

These steps can ease symptoms at home ^[2]:

• Keep the rash clean and dry to lower the risk of infection ^[2].
• Use a cool compress a few times a day, such as a wet cloth or a frozen bag wrapped in a towel ^[2].
• Do not let dressings stick to the rash ^[2].
• Avoid clothes with rough fibers that irritate the skin ^[2].

Carbamazepine is usually the first treatment for trigeminal neuralgia

Treatments help most people to some degree. The condition is usually long-term, though, and pain-free periods often get shorter over time ^[1].

If carbamazepine stops helping, causes too many side effects or cannot be taken, a referral to a specialist may follow ^[1]. When pain fades, stopping carbamazepine should be done slowly over days or weeks unless a doctor says otherwise ^[1].

For older adults, age alone should not automatically rule out surgery to move blood vessels for an otherwise suitable patient. Doctors weigh the type of neuralgia, general health, anesthesia risk, imaging, how urgent the pain is, and your preferences ^[3].

Trigeminal neuralgia affects mood and daily life beyond the pain itself

Living with trigeminal neuralgia can be very hard. It can lead to weight loss and isolation ^[1]. It can also affect eating, personal care and quality of life ^[3].

Studies describe anxiety and depression in people with this pain. Qualitative studies also describe fear, hopelessness, emotional exhaustion and suicidal thoughts ^[6]. People also report strained relationships, trouble at work, and feeling that their suffering was not taken seriously in health care settings ^[6]. Nursing guidance calls for pain assessments that cover physical, emotional and social suffering, not only pain intensity ^[6].