It is extremely uncomfortable to experience sudden and sharp facial pain. It is also stressful to experience pain without knowing why it’s happening. In desperate circumstances, you may reach for the easiest explanation for consistent facial pain.
Trigeminal neuralgia (TN) is when the trigeminal nerve that carries sensations to the face is damaged or irritated. TN causes unexpected and severe pain in the jaw, cheek, or lips. This chronic pain condition is highly disruptive but also medically treatable.
But TN is not the only medical condition that has these symptoms. Many other—relatively common—conditions also cause similar uncomfortable sensations that are often immediately mistaken as TN. Before assuming TN is the culprit, rule out these seven other conditions that could be the source of facial pain.
What is Trigeminal Neuralgia?
“The trigeminal nerve is responsible for sensation in the face,” says Dr. Zev Schulhof, a surgeon at the Iconic Implants Institute. He says compression and damage to this nerve can sometimes lead to TN, but Dr. Jerry Friedman, a surgeon at North Jersey Oral & Maxillofacial Surgery, says the exact root cause of TN remains unknown. Symptoms include intense shooting or stabbing pain in the cheeks, jaws, teeth, or lip areas that can last anywhere from a few seconds to minutes. It commonly affects only one side of the face and could become more frequent or worse over time. Receiving an accurate diagnosis—whether TN or otherwise—allows patients to receive speedy intervention for pain management.
What can be mistaken for Trigeminal Neuralgia?
While TN is one of the most common causes of facial pain, several other common issues are often mistaken for the chronic nerve condition.
Dental Problems (Toothaches, abscesses)
It can be difficult to differentiate between a toothache or abscess and trigeminal neuralgia. “Since the pain often impacts the teeth or jaw, it’s easy for dental issues…to be mistaken for TN,” says Dr. Friedman. To know the difference, doctors usually assess where the pain is happening and what it feels like.
The American Association of Neurological Surgeons describes TN pain as stabbing, intense, and electric shock-like. Dental pain tends to be a more of a localized ache.
Sinus Infections (Sinusitis)
Sinus infections or sinusitis can be mistaken for TN because of the general location of the pain, says Dr. Schulhof. Sinus infections can cause facial pain, tenderness, and headaches. Unlike TN though, sinus infections tend to cause nasal congestion and fevers. They are treated with antibiotics, antihistamines, and/or over-the-counter medication as recommended by a health care professional. Check with a physician who can conduct an examination or do a facial CT scan to diagnose sinusitis.
Temporomandibular Joint (TMJ) Disorders
Temporomandibular joint (TMJ) disorders are conditions that cause dysfunction and pain in the jaw joint and surrounding muscle area that controls jaw movement. Like TN, TMJ disorders cause facial pain and discomfort around the jaw. However, TMJ disorders impede jaw movement, potentially locking the jaw and making chewing more difficult. TMJ disorders could also cause jaw clicking noises. Consult with a doctor if you’re experiencing persistent pain and difficulty opening and closing the jaw. A physical exam or medical imaging can help diagnose a TMJ disorder.
Headaches (Cluster headaches, Migraines)
“Since the pain often impacts the teeth or jaw, it’s easy for dental issues or cluster headaches to be mistaken for TN,” says Dr. Friedman. But cluster headaches have different pain patterns and triggers than TN. Cluster headaches linger and occur behind the eye, whereas TN feels more like a shocking, electric pain that comes in short bursts. TN also commonly occurs on only one side of the face and the around the jaw and mouth area. Headaches tend to be due to light sensitivity. Dr. Friedman says TN can be brought on by chewing, brushing teeth, or being out in the cold.
Less common conditions mimicking Trigeminal Neuralgia
There are also additional conditions that could mimic symptoms of TN.
Temporal Arteritis (Tender scalp, headache, fever in older adults)
Temporal Arteritis, often also referred to as giant cell arteritis, is the inflammation of arteries and blood vessels in the head and near the temples; it can cause blindness. Giant cell arteritis can cause headaches, jaw pain, and scalp tenderness, so it’s easily mistaken for TN. See a doctor as soon as possible if you experience any of these symptoms and vision issues.
Post-Herpetic Neuralgia (Facial pain after shingles)
Post-herpetic neuralgia (PHN) is a common complication from shingles, which causes a burning sensation in the nerves and skin. PHN affects only specific parts of the skin and persists after the blisters and rash from shingles disappear. Consult your doctor if you have had a shingles rash in the area where you’re experiencing pain.
Multiple Sclerosis (Numbness, weakness, along with facial pain)
Multiple sclerosis (MS) is a disease affecting the brain and spinal cord. MS can eventually affect nerve fibers. It can present quite differently between patients, but could include numbness, weakness, and facial pain. TN can be a side effect of multiple sclerosis. If you are experiencing TN-like symptoms, ask for a neurological exam or an MRI scan to also get assessed for multiple sclerosis.
Diagnosis of Trigeminal Neuralgia
If you’re experiencing facial pain, it’s important to consult a health care professional to assess possible underlying causes. I could be TN or another condition entirely. A doctor will likely do an extensive medical history review, a physical examination, or even order imaging or laboratory tests to rule out possible causes. If diagnosed with TN, there are treatments to reduce or resolve the pain, like medication, nerve block injections, surgery, or integrated treatment like acupuncture.