Trigeminal Neuralgia Treatment with Dr. Shah-Naz Khan, Neurosurgeon in Flint, MI
Trigeminal neuralgia is a chronic condition that causes sudden, severe, electric-shock-like pain on one side of the face. It usually happens when a blood vessel presses on the trigeminal nerve near the brainstem. Treatment begins with medication and, when that stops working or causes side effects, can include microvascular decompression (MVD), a lasting surgical fix, or other targeted procedures.
What it is
Sudden, severe facial pain from irritation of the trigeminal nerve, the main sensation nerve of the face.
Who it affects
More common after age 50 and slightly more often in women, though it can occur at any age.
What it feels like
Brief bursts of stabbing or electric-shock pain in the cheek, jaw, or around the eye, usually on one side.
Common triggers
Light touch, chewing, talking, brushing teeth, a cool breeze, or even a smile.
Main treatments
Nerve-calming medication first, then microvascular decompression, rhizotomy, or radiosurgery.
What is trigeminal neuralgia?
Trigeminal neuralgia (sometimes called tic douloureux) is a disorder of the trigeminal nerve, the fifth cranial nerve, which carries feeling from your face to your brain. When this nerve misfires, it produces sudden attacks of intense, stabbing or electric-shock-like pain in the face.
The pain is usually on one side and follows the nerve's branches, so it may be felt in the cheek, jaw, teeth, gums, lips, or around the eye. Attacks are often brief, lasting seconds to a couple of minutes, but they can come in rapid clusters, and everyday things like eating, talking, or a light touch can set them off.
In most cases, the cause is a blood vessel pressing on the trigeminal nerve where it leaves the brainstem, wearing away its protective coating. Because that is a blood-vessel problem, treating it sits within Dr. Khan's field of cerebrovascular neurosurgery. See cerebrovascular neurosurgery →
Typical vs. atypical
When should you see a specialist for facial pain?
Trigeminal neuralgia is not usually an emergency, but severe facial pain deserves a proper diagnosis. New facial weakness or numbness is a different situation and needs prompt evaluation.
Get prompt medical care if…
These are not typical trigeminal neuralgia and can point to another cause that should be checked without delay.
- New numbness, drooping, or weakness in the face, rather than pain alone
- Facial pain with a new severe headache, fever, vision changes, or a rash
- Facial pain that began after a head or face injury
- Pain on both sides of the face at once, or new facial pain in someone under 40
See a neurosurgeon soon if…
Worth a specialist's review rather than living with the pain or making repeated dental visits.
- Sharp, shock-like face pain triggered by touch, chewing, or talking
- Pain that started or continued despite dental treatment that did not help
- Medication that no longer controls the pain, or that causes side effects you cannot tolerate
- You want to know whether surgery like microvascular decompression could give lasting relief
What causes trigeminal neuralgia?
Most trigeminal neuralgia comes from pressure on the nerve, but other conditions can cause similar pain, which is why an accurate diagnosis matters.
Common underlying causes
- A blood vessel pressing on the trigeminal nerve near the brainstem, the most frequent cause
- Gradual wear on the nerve's protective myelin coating over time
- Multiple sclerosis, which can damage the same coating (a less common cause)
- Rarely, a tumor or cyst pressing on the nerve
Things that trigger attacks
- Lightly touching the face, shaving, or applying makeup
- Chewing, drinking, or brushing your teeth
- Talking, smiling, or laughing
- A breeze, cold air, or washing your face
How is trigeminal neuralgia diagnosed?
Diagnosis is based mainly on your description of the pain, supported by imaging to find a cause and rule out other conditions.
Your history & exam
The pattern of the pain, its triggers, and a neurological exam of facial sensation are often enough to strongly suspect trigeminal neuralgia.
High-resolution MRI
A detailed MRI can show a blood vessel pressing on the nerve and help rule out multiple sclerosis or a tumor. A special MRA sequence can map the vessels involved.
Dental & sinus review
Because face and tooth pain overlap, a dental or sinus cause is considered and excluded so treatment targets the right problem.
How is trigeminal neuralgia treated?
Treatment almost always starts with medication. When medication stops working or causes side effects, several procedures can give strong, often lasting relief.
Medication
Nerve-calming medicines such as carbamazepine or oxcarbazepine reduce or stop attacks for many people, and are usually tried before any procedure is considered.
Microvascular decompression
Through a small opening behind the ear, the surgeon gently moves the offending blood vessel off the trigeminal nerve and cushions it. Because it treats the cause, MVD offers the most durable relief for suitable patients.
Percutaneous rhizotomy
A needle guided to the nerve uses heat, a balloon, or glycerol to interrupt the pain fibers. It avoids open surgery and can suit patients for whom MVD is not ideal.
Stereotactic radiosurgery
Precisely targeted radiation, such as Gamma Knife, is aimed at the nerve. There is no incision, and relief tends to build gradually over weeks.
Choosing the right treatment for your pain
The best option depends on how well medication is working, your age and overall health, whether an MRI shows a blood vessel on the nerve, and your own preferences about surgery versus a less invasive procedure.
Because Dr. Khan treats the blood-vessel cause behind most trigeminal neuralgia, she can talk you through whether microvascular decompression, a rhizotomy, or radiosurgery fits your case. Every case is reviewed personally, and a procedure is recommended only when it is genuinely in your interest. Second opinions are welcomed. Request a second opinion →
What shapes the plan
Recovery and what to expect
Recovery depends on which treatment you have. Needle procedures and radiosurgery are typically done without a hospital stay or with a very short one, while microvascular decompression involves a hospital stay and a few weeks of taking it easy as you heal.
Many people feel meaningful relief quickly after microvascular decompression or a rhizotomy, whereas relief after radiosurgery usually builds over several weeks. Your care team will explain your specific recovery, activity limits, and how any medications will be adjusted. These are general patterns, not a promise about any one person's result.
Follow-up matters, so your neurosurgeon can confirm the pain is controlled and adjust the plan if attacks return over time.
General recovery patterns
Facial pain care from a fellowship-trained neurosurgeon
Shah-Naz Khan, MD, FRCSC, FAANS is a fellowship-trained neurosurgeon who completed subspecialty training in cerebrovascular and endovascular neurosurgery at the Mayfield Clinic, University of Cincinnati. Because most trigeminal neuralgia is caused by a blood vessel pressing on a nerve, it fits squarely within her expertise in the vessels of the brain.
She founded the Institute of General and Endovascular Neurosurgery in Flint, Michigan in 2014 on a simple standard: excellence, ethics, and integrity. Every case is personally evaluated by Dr. Khan, a procedure is recommended only when the benefit clearly outweighs the risk, and second opinions are genuinely welcomed. Explore cerebrovascular neurosurgery →
Why patients choose IGEN
- Board-certified, fellowship-trained neurosurgeon
- Experienced in microvascular decompression, the surgery that treats the cause
- Every case personally reviewed by Dr. Khan, not delegated
- A procedure advised only when the benefit clearly outweighs the risk
- Second opinions welcomed
Trigeminal neuralgia: frequently asked questions
What does trigeminal neuralgia feel like?
What causes trigeminal neuralgia?
Can trigeminal neuralgia be cured?
What is microvascular decompression (MVD)?
Do I need surgery, or can medication be enough?
Is trigeminal neuralgia related to multiple sclerosis?
Do I need a referral to see Dr. Khan about facial pain?
Living with facial pain? Get a clear diagnosis and a plan.
Whether medication has stopped working or you simply want to understand your options, Dr. Khan will review your case personally and explain whether microvascular decompression or another treatment could bring lasting relief.
- Request a consultation by phone or through the contact form.
- Share any MRI scans or records you already have so nothing is repeated needlessly.
- Meet Dr. Khan for a personal review, a clear explanation, and honest next steps.