Fifth neuralgia: its causes and the latest treatment options

Inflammation of the fifth nerve

Fifth neuralgia is a painful condition that affects certain nerves in the face. The attacks of pain come in short, unexpected attacks that can last from a few seconds to about two minutes. The attacks stop as suddenly as they started.

What is fifth neuritis?

Trigeminal neuralgia pain comes in the form of an electric shock, sometimes severe.
It is possible for the pain to improve or disappear completely for several months or years (remission period), although these periods tend to become shorter with time.

Living with trigeminal neuralgia is very difficult, and trigeminal neuralgia greatly affects a person's quality of life and often leads to other problems such as weight loss, isolation, and depression.

To learn more about neuritis 5, it is important to know its location in the face.

Symptoms of fifth neuritis

People with inflammation may think they have a root lesion in a tooth.

In people with atypical trigeminal neuralgia, also known as type 2 disease, the pain is less severe but persistent.

Doctors consider episodes of sudden and severe pain to be a symptom of classic fifth neuritis, but if the nature of the pain is a burning feeling, it is often the second type.

Common symptoms of fifth neuritis include:

  • It comes in episodes that last from a few seconds to several minutes.
  • Attacks are repeated several times a day or week, followed by periods when no pain occurs. These pain-free periods are known as symptom remission (remission)
  • Briefly tingling feeling.
  • Pain caused by things such as brushing teeth, shaving, washing the face or applying makeup, even a light breeze on the face can cause pain.
  • The pain usually affects only one side of the face.
  • During an attack, the pain often increases in intensity over time.
  • The pain occurs mainly in the cheek, jaw, teeth, gums and lip, while the eyes and forehead are less affected.
  • After the seizure ends, the face may tremble involuntarily.
  • Some people with fifth nerve palsy experience anxiety because it is not known when the next severe pain attack will occur.

Trigeminal neuralgia triggers

  • Gently touch the face
  • shaving
  • Facial Wash
  • brushing teeth
  • Make up
  • Eating and drinking, especially hot and cold foods and drinks
  • talking
  • smiling
  • Wind blowing or breeze on the face

However, sometimes an attack of pain occurs without a trigger.

Causes of fifth neuritis

Fifth neuralgia may occur as a result of one of these reasons:

  • Pressure from a nearby blood vessel, damaging the protective layer surrounding the nerve called the myelin sheath.

Vascular pressure on the fifth nerve
Vascular pressure on the fifth nerve

  • Some diseases, such as multiple sclerosis, damage the myelin sheath.
  • The nerve can also be injured as a result of surgery, accident or stroke.
  • Some people are more likely to develop fifth neuritis than others:

  1. Women are more likely to have fifth neuritis than men.
  2. Fifth neuralgia usually appears in people over 50 years of age.
  3. People in families with infected people.

When do we seek medical advice?

  • You should see your dentist if you feel recurrent or persistent pain in the face, especially if the usual analgesics such as paracetamol and ibuprofen do not relieve the pain.
  • When the dentist denies any dental problem, the general practitioner should be consulted, who will try to identify the problem by asking about the symptoms and excluding other conditions that may be the cause of the pain.

However, trigeminal neuralgia can be difficult to diagnose and can take a few years for a diagnosis to be confirmed.

Diagnosis of fifth neuritis

  • If the facial pain occurs frequently and does not respond to analgesics, then you should see a doctor.
  • The doctor will usually ask how the pain first appeared, how often it occurs, and what triggers it.
  • A neurological exam may be done where the doctor touches different parts of the face and monitors reactions to see if the nerve is pinched.
  • Imaging tests such as an MRI can show whether a tumor or multiple sclerosis is causing the problem.

Fifth neuralgia treatment in Turkey

Treatments available at the center include: Bimaristan's Center In Turkey medicines and the latest surgical methods.


Ordinary pain relievers don't work well for people with fifth neuritis, so your doctor may prescribe different types of medication, such as:

  1. To prevent severe pain due to irritation of this nerve, you can take anticonvulsant drugs such as carbamazepine, which is often used to treat epilepsy. As the pain subsides, carbamazepine should always be stopped slowly, over a period of days or weeks, unless otherwise advised by your doctor.
  2. Muscle relaxants can also be taken (alone or with anticonvulsants).
  3. Your doctor may suggest tricyclic antidepressants to control symptoms.
  4. Some research suggests that Botox injections may be helpful when other medications don't relieve fifth nerve pain, though more research is needed before doctors can prescribe this on a large scale.


The effectiveness of drugs decreases over time, and when that happens, we have several surgical options, some of which are done in clinics, meaning that the patient does not have to enter the hospital. The doctor determines the appropriate surgery for the patient based on his general health, the nerves involved, and the patient’s personal preferences.

Stereotactic radiosurgery (Gamma Knife)In this surgery, the surgeon directs a focused dose of radiation to the root of the trigeminal nerve.
This surgery uses radiation to destroy the trigeminal nerve and reduce or eliminate pain. Recovery occurs gradually and may take up to a month.

Gamma Knife treatment
Gamma Knife treatment

balloon pressure, where doctors insert an empty balloon into the space between the trigeminal nerve and the base of the skull and when the balloon is inflated, the nerve is compressed against the solid bone, damaging the nerve's insulation, blocking pain signals.

Treatment of inflammation of the fifth nerve by balloon

glycerol injection, which is injected into the spinal fluid surrounding the trigeminal nerve, and this damages the insulation around the nerve, relieving pain.

Radiofrequency ablationWhere the doctor and patient together determine the exact area from which the pain is coming, then the doctor sends an electric current to that spot to relieve the pain.

MVD Microvascular Decompression, where the blood vessels pressing on the nerve are moved or removed, this process provides immediate pain relief in 95% of patients, about 20% of patients experience recurrence of pain within 10 years, the main benefit of which is that it does not cause numbness For the face, it is simple, the main disadvantages are the risks of anesthesia as well as the risk of an operation near the brain.

Dorsal selective root cutting, which is an irreversible cut of the root of the trigeminal nerve at the area of its attachment to the brainstem, a small opening is made in the back of the skull and a stimulus probe is used to locate the motor root of the nerve, the motor root that controls the masticatory muscles must be preserved, the sensory root fibers, which transmit Pain signals to the brain, cutting the nerve causes permanent facial numbness and this option should only be considered for recurrent pain that does not respond to other treatments.

Peripheral neurectomy, a type of surgery that can be performed on nerve branches through a small incision in the skin, the supraorbital nerve (branch of Section I v1) may be appropriate if the pain is isolated in the area above the forehead, and the infraorbital nerve (branch of the Section V2) If the pain is confined to the area below the eye along the facial bone, cutting the nerve causes complete numbness in the area it innervates.


No particular procedure is best for all patients, as each procedure differs in its effectiveness and side effects.

Reducing microvascular pressure MVD Radiofrequency ablation and radiofrequency ablation have similar rates of long-term pain relief, which are among the highest of the other available options.

In a study of approximately 100 or more patients published in the past 10 years, pain relief rates were 77% for MVD and 75% for radiofrequency ablation.

Trigeminal neuralgia can recur in sections of the nerve that were previously free of it. This can occur after all previous treatments and may be a development of the underlying disorder and not a re-emergence.

Physiotherapy for trigeminal neuralgia

There are some alternative methods that may help control the symptoms of facial neuritis that you may want to ask your doctor about:

  • Acupuncture (a Chinese tradition that uses very fine needles to balance the flow of energy in the body)
  • Aromatherapy (use of plant oils such as peppermint, lavender, etc. to aid in healing)
  • yoga
  • Biofeedback (how to control body functions to reduce pain)

Although the pain can be very severe in trigeminal neuralgia, it is not a life-threatening condition.


  1. NHS
  2. American Association of Neurological Surgeons
  3. Medscape
  4. WebMD

Frequently Asked Questions

Yes, there are multiple effects, including: drowsiness, imbalance, nausea, rashes, and others.

Neither of these medications are effective in treating fifth neuritis.

No, although it affects women more than men, it also affects men.

If you are planning for treatment in Turkey
you can talk to us here.

If you are planning for treatment in Turkey
you can talk to us here.