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Severe Facial Pain as a Symptom of Multiple Sclerosis

Trigeminal Neuralgia or Tic Doloreux and MS


Updated May 20, 2014

Trigeminal Neuralgia and MS
David De LossyCollection/Digital Vision/Getty Images

Trigeminal neuralgia has to be one of the worst symptoms that people with multiple sclerosis (MS) experience. A couple of readers have written to me about this symptom and said that there were no words to describe the intensity of their pain. It is one of the types of pain described as “neurogenic pain” or “primary pain,” meaning it is the direct result of the disease process of multiple sclerosis, caused by demyelination and lesions on specific nerves.

What Does It Feel Like?

Trigeminal neuralgia, often called tic doloureux (French for “painful twitch”), is perhaps the most intensely painful MS-related symptom. It can be described most commonly as:
  • occurring in the lower part of the face (often triggered by chewing, drinking or brushing one’s teeth)
  • intense, sharp pain
  • like an electrical jolt
  • usually the most intense pain is short-lived (from a few seconds to up to two minutes), but can result in a more constant burning or aching

However, it should be noted that it can also have the following characteristics:

  • extending as far as the ear, and often mistaken for the pain of an ear infection
  • can be triggered by loud sounds

How Common Is It?

Trigeminal neuralgia is fairly rare, with only 4% of people with MS experiencing this kind of pain. However, people with MS are 400 times more likely than the general population to have an episode of trigeminal neuralgia.

What Causes It?

Trigeminal neuralgia pain can be brought on by chewing or touch. It is caused by lesions on the trigeminal nerve, which is also called the fifth cranial nerve. (The 12 cranial nerves emerge directly from the brain instead of from the spinal cord.) The trigeminal nerve controls the muscles needed for chewing, and is responsible for most facial sensation.

How Severe Can It Get?

Trigeminal neuralgia can get so severe and so distressing that it can require hospitalization and intravenous painkillers. It can interfere with a person’s intake of food and fluids and require that these also be supplemented intravenously. Some people may require surgery for this symptom. However, it is rare that it ever gets this severe.

Due to the intensity of this symptom, anxiety and fear about the possibility of it recurring can cause unnecessary suffering and interfere with daily life, even when the symptom is not present.

Additional Points/Information

Tends To Be Episodic: Each “bout” with trigeminal neuralgia usually lasts a couple of weeks. However, this symptom tends to recur and can happen as often as every couple of months. Some people will go years between episodes of this symptom. Unfortunately, as time passes, time between episodes gets shorter.

Hold Off On the Root Canals: Given the location and nature of the pain associated with trigeminal neuralgia, it is often mistaken for dental pain. This could lead to unnecessary (and irreversible) procedures like tooth extractions, root canals and even procedures to reposition the jaw. Make sure that you see your neurologist if you are experiencing this kind of pain, especially before undergoing any kind of drastic dental work.

Appears Early: Trigeminal neuralgia tends to be one of the first symptoms of multiple sclerosis for those who experience it.


Turkington, C. and Hooper, K. The A to Z of Multiple Sclerosis. Entry on “trigeminal neuralgia.” New York: Checkmark Books, 2005.

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