Nerve Pain & Trigeminal Neuralgia

If you've been told your facial pain is unexplained, or that nothing shows up on imaging despite pain that's very real and very disruptive, you're not imagining it — and you're not out of options. Orofacial nerve pain conditions are notoriously hard to diagnose, not because they aren't real, but because they don't always show up on a standard scan. Getting the right diagnosis is the turning point most patients are missing.

Nerve pain shows up differently depending on its source, and getting the category right changes everything about treatment. Here's what we evaluate for:

Trigeminal Neuralgia (TN)

• Type 1: sudden, severe, electric shock–like pain in brief episodes, often triggered by light touch, chewing, or brushing teeth
• Type 2: a constant burning or aching background pain, sometimes with episodic spikes layered on top
• Typically unilateral, following the distribution of one or more branches of the trigeminal nerve

Atypical Facial Pain / Persistent Idiopathic Facial Pain

• Constant, poorly localized facial pain without a clear structural or dental cause
• Often described as aching or pressure-like rather than sharp
• Requires ruling out depression, other neuropathies, and central sensitization as contributors before the diagnosis is made

Post-Traumatic Facial Pain

• Pain, numbness, tingling, or altered sensation following dental procedures, oral surgery, extractions, or facial trauma
• Can involve the lip, tongue, gums, or cheek depending on which nerve is affected

Burning Mouth Syndrome

• Chronic burning sensation affecting the tongue, lips, gums, or whole mouth, often without a visible cause
• Frequently accompanied by dry mouth and altered or reduced taste
• Contributing factors can include hormonal changes, nutritional deficiencies, certain medications, and stress

Facial Pain from TMJ Disorders

• Radiating pain into the cheeks, temples, ears, or eyes, originating from the jaw joints or muscles of mastication
• Often mistaken for a primary headache or ear condition before the jaw connection is identified

Getting to an accurate diagnosis takes more than a single visit. A thorough evaluation typically includes:

• Comprehensive pain history — quality, distribution, triggers, response to prior treatments
• Cranial nerve exam
• Joint and muscle assessment to rule in or out orofacial contributors
• Review of prior imaging and specialist reports
• Diagnostic nerve block when clinically appropriate

There's no single treatment for nerve pain — what works depends entirely on which condition is driving it. Approaches may include:

• Pharmacological management for TN and other neuropathic pain — anticonvulsants, tricyclics, and topical agents, prescribed and monitored carefully.
• Trigger point therapy for muscle-mediated pain.
• Oral appliance therapy when TMJ or bruxism is part of the picture.
• Nerve block procedures where indicated for diagnosis or short-term relief.
• Coordinated referral with neurologists and neurosurgeons for TN cases that may need surgical intervention.