Imagine a pain so sharp and intense that you lose your breath when it comes out of nowhere. It is blinding, literally and figuratively, as it shoots across your face, across the top of your head, and down the sides of your neck. If you have trigeminal neuralgia, you don’t need to imagine this pain – you know it well. Knowing what causes trigeminal neuralgia to flare up is the first step in avoiding this breath-taking pain. Here are 12 of the most common trigeminal neuralgia triggers.

What is trigeminal neuralgia?

Trigeminal neuralgia is searing neuropathic facial pain that originates in the trigeminal nerve, located just behind the mandible near the temporomandibular joint. This nerve has three branches that transmit sensations from the face and inside the mouth to the brain.

There are a few different potential causes of trigeminal neuralgia, including:

  • Pressure on the trigeminal nerve, usually by a blood vessel exiting the brain stem, which wears away the protective coating around the nerve (the myelin sheath)
  • Multiple sclerosis, a disease that causes deterioration of the myelin sheath
  • Trigeminal nerve compression from a tumor
  • Arteriovenous malformation (tangled arteries and veins)
  • Injury to the trigeminal nerve (due to sinus surgery, oral surgery, stroke, or facial trauma)

This neuropathic facial pain can take many forms. Some patients experience sharp, electric jolts that last only a few seconds. Others may have a constant ache or burning feeling. There may be days, weeks, or months without pain, followed by painful episodes of varying lengths of time.

Pain is usually confined to one side of the face, although some patients will have pain across the whole face. This disorder is most common is women and occurs most frequently in people over 50.

What causes trigeminal neuralgia to flare up?

Every person suffering from trigeminal neuralgia has different triggers. Here are 12 of the most common trigeminal neuralgia triggers.

1. Stress

Stress is a major intensifier of pain of all kinds. Why it works on the body the way it does is not precisely known, but it can trigger and increase trigeminal nerve pain.

2. Certain foods

Caffeine, sweets, and spicy foods may be triggers for some patients. These may trigger the branches of the trigeminal nerve that enervate the inside of the mouth, or it may be the way in which these foods interact in the body.

3. Alcohol

Alcohol interacts with the blood vessels and can also cause dehydration. Either of these may be why alcohol is a profound trigger of trigeminal neuralgia.

4. Touch

Even the slightest touch can cause a painful episode.

5. Shaving

The combination of water on the face, pulling the hairs as you shave, and the touch of the razor may make pain flare up.

6. Shower jets

Many people with trigeminal neuralgia cannot have shower jets, however gentle, directly on their faces.

7. Change in barometric pressure

The swing between high and low pressure can trigger headaches and sinus pain, both of which can be caused by trigeminal neuralgia.

8. Cold and wind

Wind on the face, particularly cold wind (or even just coldness in general), may constrict blood vessels and cause pain.

9. Blood pressure increase

Any pressure in the veins and arteries can place pressure on the trigeminal nerve. If nerve pressure is the main cause of your pain, this can trigger an episode.

10. Teeth cleaning

Many people with trigeminal neuralgia avoid the dentist, not due to anxiety about their teeth but in fear of the pain that might result. The trigeminal nerve transmits signals to the brain from inside the mouth, and a simple teeth cleaning can cause excruciating pain.

11. Putting on makeup

Even the lightest touch of a makeup brush can stimulate the trigeminal nerve.

12. Smiling

Smiling (or frowning) stimulates the muscles and nerves in the face and can trigger pain. This can be especially defeating for people who are really trying to smile through their pain.

How to avoid trigeminal neuralgia triggers

One thing is certain: trigeminal neuralgia triggers are hard to avoid. The everyday nature of what causes trigeminal neuralgia to flare up means that tracking symptoms is crucial.

Pain tracking apps can be your best weapon in fighting the pain. Simply taking note of what causes the pain to flare up (and when) means you can more easily prevent (or limit) your painful episodes.

Here are five of our favorite pain tracking apps:

  • My Pain Diary
  • PainScale
  • Manage My Pain (Android phones only)
  • Chronic Pain Tracker
  • Flaredown

How to treat trigeminal neuralgia pain

Trigeminal neuralgia flare up treatment starts with a proper diagnosis. Many patients report their struggles in getting a proper treatment, traveling from doctor to doctor until they figure out the cause of their pain. Be persistent. If your symptoms match the symptoms of trigeminal neuralgia, you may need to visit multiple doctors before receiving a definitive diagnosis.

There are a number of ways this challenging pain can be treated, from prevention to treatment of the underlying cause to managing any flare-ups.


Anticonvulsants are used for prevention of flare-ups and to calm anxiety that may occur when a flare up is imminent. These prescription medications include:

  • Tegretol
  • Carbatrol
  • Oxcarbazepine (Trileptal)
  • Lamotrigine (Lamictal)
  • Phenytoin (Dilantin, Phenytek)
  • Clonazepam (Klonopin)
  • Gabapentin (Neurontin, Gralise, and others)

Antispasmodic agents

These muscle-relaxers (e.g., baclofen) may be used alone or combined with carbamazepine. There are side effects that can include confusion, nausea and drowsiness.

Botox injections

Botox (botulinum toxin A) injected in the muscles of the jaw may reduce pain when other treatments are not successful.

Surgical options

Depending on the cause and severity of your trigeminal neuralgia, you may have surgical options. Microvascular decompression relieves pressure on the trigeminal nerve with a small incision behind the ear (and careful movement of the arteries).

Brain stereotactic radiosurgery (a.k.a gamma knife) uses a small dose of focused radiation to damage the trigeminal nerve enough to reduce or eliminate pain. Balloon compression acts in much the same way, as does radiofrequency thermal lesioning, damaging the nerve’s pain signals.

Some patients combine these treatments with other therapies such as acupuncture, biofeedback, chiropractic, and trigger reduction therapy. It is important to work closely with your doctor to find treatments that can work for you.

If you are experiencing the symptoms of trigeminal neuralgia but need dental work, get in touch today. Our gentle dentists are experts at treating patients with highly sensitive and painful conditions. We can suggest some modifications to help you. Contact AZ Dentists today for more information.

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