Trigeminal Neuralgia, TMJ or Atypical Facial Pain? How to Tell the Difference
Three conditions cause most of the long lasting facial pain a headache specialist sees: trigeminal neuralgia, TMJ dysfunction and atypical facial pain. They can feel alike at first, and they are often confused with dental or sinus problems. The way the pain behaves is usually the best clue to which one you have.
Trigeminal neuralgia: sudden electric shocks
The trigeminal nerve carries feeling from the face to the brain. In trigeminal neuralgia, that nerve sends sudden, severe, shock like pain into the cheek, jaw, teeth, forehead or around the eye.
How it feels: sharp, stabbing, electric; often described as the worst pain a person has felt
How long: a few seconds to a couple of minutes per attack, sometimes in rapid bursts
Triggers: chewing, talking, brushing teeth, shaving, a light touch or a cold breeze
Side: almost always one side of the face, following the branches of the nerve
Common cause: pressure on the nerve, often from a blood vessel; sometimes linked to multiple sclerosis, and sometimes no cause is found
Learn more about trigeminal neuralgia.
TMJ dysfunction: jaw joint and muscle pain
The temporomandibular joints connect the jaw to the skull just in front of the ears. TMJ dysfunction (TMD) affects these joints and the muscles that move the jaw.
How it feels: aching or tight pain in the jaw, in front of the ear or at the temples
How long: often steady, worse after chewing, clenching or in the morning after grinding
Other signs: clicking or popping, a jaw that feels stuck, limited opening, tension headaches
Common causes: teeth grinding (bruxism), clenching, jaw injury, arthritis, posture and stress
Learn more about TMJ dysfunction.
Atypical facial pain: constant and hard to pin down
Atypical facial pain is a long lasting pain in the face or jaw that does not follow the pattern of a single nerve and has no clear trigger.
How it feels: dull, aching or burning
How long: present most of the day, most days
Where: often a wide or shifting area, sometimes after dental or facial procedures
Triggers: usually none that the patient can point to
Learn more about atypical facial pain.
Side by side
Trigeminal neuralgia
Pain type: Electric, stabbing
Attack length: Seconds to minutes
Triggers: Touch, chewing, talking
Location: One side, along a nerve
Jaw clicking: No
TMJ dysfunction
Pain type: Aching, tight
Attack length: Hours, often daily
Triggers: Chewing, clenching, grinding
Location: Jaw, ear, temples
Jaw clicking: Often
Atypical facial pain
Pain type: Dull, burning
Attack length: Constant
Triggers: Usually none
Location: Wide or shifting
Jaw clicking: No
Some people have more than one of these at the same time, and migraine or cluster headache can also be felt in the face. That is why a careful exam matters more than any single symptom.
How each one is treated
Dr. Fred Cohen, a board certified headache medicine specialist affiliated with Mount Sinai Hospital, treats all three. Plans are tailored to the cause and often combine:
Trigeminal neuralgia: nerve pain medicines, Botox injections, trigeminal nerve blocks, sphenopalatine ganglion (SPG) blocks and neuromodulation, with referral for surgical options when needed
TMJ dysfunction: Botox for TMJ in the jaw and temple muscles, trigger point injections, and work alongside your dentist on bite and grinding
Atypical facial pain: medicines, Botox injections, facial nerve blocks and lifestyle changes
See a facial pain specialist in New York City
Dr. Cohen sees patients in Manhattan, Brooklyn and Astoria, Queens, and in Jacksonville, Florida. Telemedicine visits are available in New York, Pennsylvania and Florida, with same day, evening and weekend appointments. Book a visit.
Frequently asked questions
How do I know if my face pain is trigeminal neuralgia?
Trigeminal neuralgia causes sudden, severe, electric shock like attacks on one side of the face that last seconds to minutes and are often triggered by chewing, talking or a light touch. A headache or facial pain specialist confirms the diagnosis with an exam and, when needed, an MRI.
Can TMJ cause headaches?
Yes. TMJ dysfunction strains the jaw and temple muscles, and teeth grinding keeps them tense, which often leads to tension headaches and can trigger migraine.
What is the difference between atypical facial pain and trigeminal neuralgia?
Trigeminal neuralgia comes in brief, sharp attacks along one nerve with clear triggers. Atypical facial pain is a constant dull or burning pain over a wider area without a clear trigger.
Does Botox help facial pain?
Botox is used for TMJ related pain in the jaw and temple muscles and as one of the treatment options for trigeminal neuralgia and atypical facial pain. Whether it fits depends on the cause of your pain.
