In many people it does, gradually. Attacks tend to become more frequent, the pain-free intervals between bouts shorten, and medication that worked well initially becomes less effective at tolerable levels. That pattern is common enough that it is worth planning for rather than waiting to discover.
In many people it does, gradually. Attacks tend to become more frequent, the pain-free intervals between bouts shorten, and medication that worked well initially becomes less effective at tolerable levels. That pattern is common enough that it is worth planning for rather than waiting to discover.
Trigeminal neuralgia produces sudden, severe, electric-shock or stabbing pain in part of the face, lasting seconds to a couple of minutes, triggered by light touch, chewing, talking, cold air or brushing teeth. Early on there are often long remissions lasting months. Over years those remissions typically shorten, attacks become more frequent within a bout, and some people develop a continuous background ache in addition to the shocks. The affected division of the nerve can also extend. None of this is universal, but it is the common direction of travel.
Carbamazepine and oxcarbazepine are the established first-line treatments and work well for most people initially. Over time two things happen. The condition itself becomes more active, so more effect is needed. And side effects - drowsiness, unsteadiness, low sodium, cognitive slowing - limit how far treatment can go, particularly in older patients. Loss of control is therefore usually a ceiling problem rather than true drug failure, and it is the signal to consider procedural options rather than to keep escalating.
Most cases involve compression of the trigeminal nerve root by a blood vessel, and that does not resolve spontaneously, which is part of why the condition tends to persist. A minority are secondary to another process, most importantly multiple sclerosis, which is particularly worth considering in younger patients, in bilateral cases, and where there are other neurological findings. Sensory loss on examination, rather than pain alone, also argues for a secondary cause. MRI is arranged at an imaging centre and the report reviewed with you here.
Once medical treatment is failing or its side effects are intolerable, procedural options become the sensible next step rather than a last resort, and delaying them achieves little. Microvascular decompression, and the various ablative and radiosurgical approaches, each have different profiles of benefit, durability and numbness. This practice performs no surgery, so assessment is arranged with a neurosurgical service while medical management continues here for adults 18 and older.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: trigeminal neuralgia; NINDS: trigeminal neuralgia; American Academy of Neurology.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.