The trigeminal nerve, also known as cranial nerve V, is the largest cranial nerve in the body. It starts in the center of the brain near the level of the ear. It has 3 branches that allow you to feel sensations of pain, touch, heat, and cold on your face. 

The 3 branches correspond to parts of the face. The upper branch goes to the forehead and eye, the middle to the cheek, and the lower to the jaw. The cranial nerves come in pairs, so you have 2 trigeminal nerves, 1 on either side of your face. Thankfully, this condition usually only affects 1 side. 

Intense pain can result from a blood vessel in the brain coming into contact with the trigeminal nerve. The blood vessel rubs against it, damaging the outer layer of insulation and exposing the highly sensitive nerve.

In some cases, other structures compress the nerve, sometimes at the base of the head where the brain meets the spinal cord.

Other causes for this type of intense facial pain include:

• Multiple sclerosis
• Tumor or cyst
• Stroke
• Facial trauma
• Surgical or dental injury

When you have a facial pain condition, you may have intense electric shock-type pain that feels like an ice pick to the cheek or jaw. People with these conditions often describe the pain as a 10 out of 10. When pain flares up, it can make it hard to eat and sleep. You may end up losing weight because of the pain.

In typical cases, your pain is throbbing, sporadic, burning, or shock-like and shows up around the eyes, lips, nose, jaw, forehead, and scalp. In other cases, your pain may be constant, burning, aching, or stabbing but less intense.

Everyday activities can trigger a pain episode: washing your face, brushing your teeth, eating, talking, or shaving. You may feel a numbness or tingling start, and then pain comes in bursts for a few seconds to a few minutes.

When you have a facial pain condition, your flares can last for weeks or months. Often, a pain-free period follows a flare in which you're worried that the pain will come back. When your pain does come back, it's often worse. 

• Trigeminal neuralgia: Also called "tic douloureux" or "painful tic," the pain of trigeminal neuralgia comes and goes with periods of relief between episodes. You may also have uncontrollable facial twitching.
• Anesthesia dolorosa: In this condition, the skin of your face is numb to the touch. You feel a burning, aching, squeezing, heavy, tight pain or pressure likened to pins and needles. You feel this pain almost all the time.
• Geniculate neuralgia: This type of facial pain is also called tic douloureux of the nervus intermedius. You feel this severe pain centered directly in the ear.
• Atypical facial pain: Also called persistent idiopathic facial pain, atypical facial pain is often duller instead of sharp, stabbing pain. It usually lasts most of the day or is a continuous aching, crushing or burning sensation.

With the help of a Carilion neurologist and neurosurgeon, we can help your facial pain improve instead of worsening. 

• Medicines: Medicines can dull your facial pain, especially when you first develop the condition. Drugs include antiseizure medicines, muscle relaxants and antidepressants.
• Pain injections: Nerve blocks are injections (with a steroid medication or Botox) made at various parts of the nerve to reduce pain. The relief is temporary.
• Noninvasive procedures: Stereotactic radiosurgery uses radiation to damage the nerve so it can no longer transmit abnormal pain signals.
• Minimally invasive procedure: A rhizotomy uses heat or a chemical to deaden the pain fibers of the trigeminal nerve. A surgeon may also use a small balloon to deaden the nerve.
• Surgery: If medicines and injections are no longer blocking your pain or if you're having too many side effects, surgery may relieve the pain. Surgery includes microvascular decompression, which places a Teflon pillow between the nerve and the blood vessel.
• Device implants: Another surgical option is peripheral nerve stimulation. The doctor puts wires in the face and around the scalp to block the pain signal.