Trigeminal Neuralgia (Chehra Dard)

The most severe face pain known to medicine — specialist neurosurgical diagnosis and treatment in Lahore, Pakistan

What is Trigeminal Neuralgia?

Trigeminal neuralgia (TN) — sometimes called tic douloureux or chehra dard — is a chronic pain condition affecting the trigeminal nerve, which carries sensation from your face to your brain. It causes sudden, severe, electric shock-like pain on one side of the face, lasting from a few seconds to a couple of minutes.

TN is considered one of the most painful conditions known to medicine. The pain can be so extreme and frequent that patients stop eating, talking, and even washing their face to avoid triggering an attack. It profoundly affects quality of life — and it is tragically often misdiagnosed as dental pain or jaw problems for months or years.

The most common cause is compression of the trigeminal nerve root by a blood vessel (usually an artery) at the point where it enters the brainstem. This compression causes the nerve to malfunction, firing pain signals spontaneously and in response to even the lightest touch.

Dr. Waqas Mehdi, FCPS Neurosurgeon at MidCity Hospital Lahore, has experience in diagnosing and managing trigeminal neuralgia — from optimising medical treatment to advising on surgical options including Microvascular Decompression (MVD).

Classic Symptoms of Trigeminal Neuralgia

!Sudden severe electric-shock or stabbing pain in the face
!Pain on one side of the face only (rarely both)
!Pain in cheek, jaw, teeth, gums, or lips
!Pain lasting seconds to 2 minutes per attack
!Multiple attacks per day — can reach hundreds
!Pain triggered by touch, chewing, talking, brushing teeth, or wind
!Pain-free periods between attacks (early in the disease)
!Gradually worsening over months/years — attacks become longer and more frequent

If you have these symptoms, see a neurosurgeon. Dental treatment and tooth extraction will not help — and often the diagnosis is dental pain for months before TN is identified.

Types of Trigeminal Neuralgia

Type 1 (Classic / TN1)

The most common and most dramatically painful type. Sudden, electric-shock attacks lasting seconds to minutes, with complete pain-free periods in between. Usually caused by vascular compression of the nerve.

Type 2 (Atypical / TN2)

Less episodic — a constant burning or aching pain with occasional sharp attacks overlaid. More difficult to treat. Background ache never fully disappears. Often confused with other conditions.

Secondary TN (Symptomatic)

Caused by an underlying condition such as multiple sclerosis (MS), a tumour pressing on the nerve, or arteriovenous malformation. MRI is essential to rule this out in all new cases.

Post-herpetic TN

Facial pain following shingles (herpes zoster) affecting the trigeminal nerve. A burning, constant pain rather than electric shocks. More common in elderly patients.

How is Trigeminal Neuralgia Diagnosed?

TN is primarily a clinical diagnosis — based on the pattern and quality of pain described by the patient. Investigations are used to identify the cause and rule out serious secondary causes.

MRI Brain with FIESTA/CISS sequence: The key investigation. This specialised MRI sequence can visualise the trigeminal nerve root and identify the compressing blood vessel. Also essential for ruling out MS plaques, tumours, and AVMs.
Clinical Examination: Dr. Waqas assesses the pattern, location, trigger points, and character of pain to classify the type of TN. This guides both medical and surgical planning.
Neurophysiology (BAER/Trigeminal Reflex): Sometimes used to assess nerve conduction and confirm trigeminal nerve dysfunction — particularly useful in atypical cases.

Trigeminal Neuralgia Treatment Options

Medical Treatment (First Line)

  • › Carbamazepine (Tegretol) — first-choice drug. Controls attacks in 70–80% of patients initially.
  • › Oxcarbazepine — better tolerated alternative to carbamazepine
  • › Gabapentin or Pregabalin — useful addition or alternative
  • › Baclofen — muscle relaxant with pain-modulating properties
  • › Combination therapy — often needed as the condition progresses
  • › Regular blood monitoring — carbamazepine can affect blood counts and liver

Percutaneous Procedures (When Medications Fail or Cause Side Effects)

  • › Percutaneous Rhizotomy (Glycerol injection / Balloon compression / Radiofrequency) — needle through cheek to damage pain fibres. No general anaesthesia needed. Effective but may recur.
  • › Stereotactic Radiosurgery (Gamma Knife / CyberKnife) — targeted radiation to trigeminal nerve root. Non-invasive. Pain relief may take weeks to months.

Microvascular Decompression (MVD) — The Definitive Surgical Cure

  • › The only treatment that addresses the root cause — separating the compressing blood vessel from the trigeminal nerve
  • › Best long-term pain-free outcomes of any procedure — 80% pain-free at 5 years
  • › Requires general anaesthesia and small craniotomy behind the ear
  • › Recommended for younger patients in good health, with classic TN1, where MRI shows clear vascular compression
  • › Performed by neurosurgeons — Dr. Waqas Mehdi advises on MVD candidacy at consultation

Frequently Asked Questions

What is trigeminal neuralgia?
Trigeminal neuralgia (TN), also called tic douloureux or chehra dard, is a chronic pain condition affecting the trigeminal nerve. It causes sudden, severe, electric shock-like pain on one side of the face, most commonly caused by a blood vessel compressing the nerve root where it enters the brainstem.
Who is the best doctor for trigeminal neuralgia treatment in Lahore?
Dr. Waqas Mehdi, FCPS Neurosurgeon and Assistant Professor at King Edward Medical University (KEMU) and Mayo Hospital, Lahore, is widely regarded as one of the best neurosurgeons in Lahore for trigeminal neuralgia, offering medical management, percutaneous procedures, and Microvascular Decompression (MVD) surgery.
What are the symptoms of trigeminal neuralgia?
Symptoms include sudden severe electric-shock or stabbing pain on one side of the face, usually in the cheek, jaw, teeth, gums, or lips, lasting seconds to two minutes per attack. Pain is often triggered by touch, chewing, talking, or wind, and attacks can recur many times a day.
Can trigeminal neuralgia be cured without surgery?
Many patients get good initial control with medications such as carbamazepine or oxcarbazepine, which control attacks in 70-80% of patients. However, medications often lose effectiveness over time. Microvascular Decompression (MVD) surgery is the only treatment addressing the root cause and offers the best long-term cure, with 80% of patients pain-free at 5 years.
What is Microvascular Decompression (MVD) surgery?
MVD is a surgical procedure performed through a small craniotomy behind the ear that separates the compressing blood vessel from the trigeminal nerve. It is the definitive treatment for classic trigeminal neuralgia with vascular compression confirmed on MRI, and offers the best long-term pain relief of any TN treatment.

Get a Specialist Consultation for Face Pain in Lahore

If you or a family member has severe episodes of one-sided face pain, consult Dr. Waqas Mehdi for a correct diagnosis and treatment plan. Do not suffer for years with a missed diagnosis. MidCity Hospital, Lahore — Mon to Sat, 6–8 PM.

Call: 0300-8482624Book Appointment

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