What is the primary cause of the severe facial pain described by a patient with trigeminal neuralgia?

The primary cause of severe facial pain in trigeminal neuralgia is often due to the compression of the trigeminal nerve, also known as cranial nerve V. This compression typically occurs at the root entry zone where the nerve exits the brainstem. Often, a blood vessel, such as an artery, can pulsate against the nerve, leading to irritation and damage over time. This results in episodes of intense, sharp, shooting pain, commonly triggered by relatively benign stimuli like light touch or movement.

While inflammation, viral infections, and trauma can play a role in other conditions affecting the trigeminal nerve, the hallmark of trigeminal neuralgia is the distinct pattern of pain associated with nerve compression. Studies show that addressing the compression surgically or through other interventions can significantly alleviate the symptoms, further supporting the identification of this mechanism as the primary cause of trigeminal neuralgia.