Face pain isn’t the most common type of pain caused by multiple sclerosis. But many people agree that it can be the most excruciating. Around 3% of people with MS also develop a complication known as trigeminal neuralgia (TN), estimates a Multiple Sclerosis & Related Disorders analysis. The condition is marked by sudden sharp, stabbing sensations (think: an ice pick ramming your face) that typically run from the ear to the nose or corner of the mouth.

“It’s often described as a machine-gun firing type of pain that typically lasts for seconds to minutes. Many of my patients who have given birth say it’s worse than childbirth,” says James Stark, M.D., senior attending neurologist and associate medical director of the International Multiple Sclerosis Management Practice in New York City.

Though TN can be agonizing, there are ways to manage your symptoms, and in some cases, even stop the pain completely. Here, experts weigh in on the most effective options.

Overview

The Link Between MS and Face Pain

Anyone can develop trigeminal neuralgia, but having multiple sclerosis can up your risk by as much as 15-fold, reports a Nature Reviews Neurology paper.

Here’s why: Multiple sclerosis is an autoimmune condition that attacks the central nervous system by destroying myelin, the protective coating of nerves that keep the brain and the rest of the body in communication. These attacks make your nerves inflamed and scarred, causing them to misfire, Dr. Stark explains.

Nerve damage from MS can happen anywhere in the body. If you’re experiencing pain in your face, it’s typically caused by damage to the trigeminal nerve. The nerve, which runs from your ear down to your jaw, is responsible for relaying sensations from your face to your brain.

A damaged trigeminal nerve is like a live wire. Even light touches or movements like chewing, talking, shaving, or a gentle breeze can make the nerve misfire, sending a shock-like sensation down the side of your face. Though everyone has two trigeminal nerves (one on either side of your face), only one side of the face is usually affected by trigeminal neuralgia, says Leah Croll, M.D., assistant professor of clinical neurology at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA.

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Experts don’t know why, but it’s more common for people with longstanding MS to develop trigeminal neuralgia, Dr. Stark notes. Still, findings published in the International Journal of MS Care estimate that around 15% of patients experience TN as an early symptom, before they’re even diagnosed with multiple sclerosis.

Medication Options

Medication Options for Face Pain Management in MS

Because TN pain is so intense, treatment is typically required to help a person feel better. “Usually we’ll start with medications… that target nerve pain,” which may help control symptoms in other parts of your body, too, Dr. Croll says.

Per the Cleveland Clinic, your doctor may prescribe:

  • Anticonvulsants. Meds such as carbamazepine, clonazepam, gabapentin, lamotrigine, phenytoin, oxcarbazepine, sodium valproate, or topiramate—work by slowing down electrical impulses in the nerves and making it hard for them to send pain messages.

  • Antidepressants such as amitriptyline or nortriptyline help ease nerve pain by tempering the reabsorption of certain chemicals in the brain.

  • Muscle relaxants such as baclofen can block pain signals.

FYI, it can take a few weeks for these meds to build up in your system to the point where you notice an improvement. So your doctor might also recommend taking an opioid pain reliever (like oxycodone) for a short period (a few days to a few weeks) to help give you some more immediate relief, Dr. Stark says. Once the worst of your symptoms have eased up, you can taper off the pain meds and just keep a few on hand to help you manage any potential breakthrough episodes.

Also good to know: Not every prescription med works for every MS patient with trigeminal neuralgia, and they can cause side effects like fatigue or dizziness. “Each medication works with a slightly different mechanism, so you may need to try a few before you find the right one,” says Dr. Stark.

Surgical Options

Surgical Treatment For MS Face Pain

If prescription medications aren’t doing enough to manage your MS face pain, or if they start to become less effective over time, your doctor might recommend a surgical procedure for your TN.

Surgery can be highly effective for TN, but it also comes with risks. “If you completely sever the trigeminal nerve, you’ll have numbness of the face, which can cause chewing problems,” says Dr. Stark, who typically refers MS patients for surgery only after they’ve tried at least three different nerve pain medications for their TN.

No one surgical procedure has been shown to be definitively better than others for managing TN in patients with multiple sclerosis, notes a review published in the Journal of Headache and Pain. So you and your doctor should weigh the pros and cons of different surgical options to decide which procedure is right for you. “Doctors will take into account a patient’s medical history, coexisting conditions, surgical risk factors, and imaging findings,” Dr. Croll says.

Stereotactic Radiosurgery

This is also called a gamma knife procedure, although no actual knife is involved. Instead, stereotactic radiosurgery involves delivering a concentrated dose of radiation to the trigeminal nerve to disrupt faulty nerve signaling. “It’s typically a first-line surgical treatment since it’s less invasive, and we’ve had a lot of success with it in recent years,” Dr. Stark says.

The downside is that it can take a few weeks after the procedure for the effects to take hold. And they’ll typically start to wear off within two to three years, according to one Neurosurgery study. (But you can have it done again.)

Glycerol Rhizotomy Injections

During this minimally invasive procedure, your surgeon will inject glycerol (a naturally occurring alcohol) directly into the center of your trigeminal nerve to damage the nerve and halt or reduce faulty signaling. It’s been shown to relieve TN pain for around 90% of MS patients for one to two years, found a Journal of Neurosurgery study.

Balloon Compression

Balloon compression is a minimally invasive procedure that uses a catheter to thread a small balloon up to your trigeminal nerve. When the balloon is inflated, the nerve gets compressed and damaged, temporarily stopping it from transmitting pain signals. (The balloon and catheter are removed at the end of the procedure.) Success rates are similar to other surgery options, but it may be more likely to cause chewing problems, according to a World Neurosurgery review.

Radiofrequency Rhizotomy

Also called radiofrequency thermal lesioning, the minimally invasive procedure involves inserting a needle into your cheek to send an electrical current to the trigeminal nerve. (Don’t worry, it doesn’t hurt—the area will be numb so you’ll only feel some pressure.) The current destroys some of the trigeminal nerve fibers, stopping the nerve from signaling pain. Results can last for three to four years, per the Cleveland Clinic.

Microvascular Decompression

Microvascular decompression is a more invasive procedure where your surgeon makes an incision behind your ear to look for a blood vessel that may be compressing your trigeminal nerve and making it misfire. From there, the surgeon will place a cushion in between the nerve and the blood vessel to reduce the compression.

Microvascular decompression can be highly effective for many people with TN. But the success rates for people with MS is as low as 20%, per a World Neurosurgery study. That may be because MS-related TN typically stems from nerve inflammation, not blood vessels compressing the trigeminal nerve, the authors note.

Open Communication

Talking With Your Doctor About MS Face Pain

Facial pain from MS can have a major effect on your everyday life, making it harder to carry out daily activities or get a good night’s sleep. So you should let your neurologist know if you’re having symptoms that sound like trigeminal neuralgia.

Together, you can come up with a plan to get your pain under control. “There are a number of treatment options available,” Dr. Croll says. “It may require a bit of trial and error in terms of trying out different options, but most people do find relief eventually.”

This article was originally published February 1, 2011 and most recently updated February 5, 2024.
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Elizabeth Carroll, M.D., Neurologist: