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The International Association for the Study of Pain describes trigeminal neuralgia (TN) as a "sudden, usually unilateral, severe, brief, stabbing, recurrent pain in the distribution of one or more branches of the 5th cranial nerve". The pain quality is usually sharp, or lancinating (cutting or tearing). It is often described as an "electric shock".

The attacks can be initiated by innocuous activities such as light touch of the skin, chewing, washing the face, and brushing the teeth. In some people the pain may begin following non-painful physical stimulation of specific areas (trigger points or zones). During an episode of TN, the severe pain may cause the patient to experience a tic or facial spasm that is the basis for the name 'tic douloureux'.

In addition to these episodic pains, some patients describe pain that is constant, burning, or pulling. Such features are considered atypical and may be associated with a nerve injury (neuropathy) as opposed to a nerve irritation (neuralgia). Patients with atypical pain may not go into remission. These patients are harder to treat as they often do not respond to treatments for trigeminal neuralgia. A number of patients have both a sharp, intermittent pain in conjunction with a more constant "background" pain.

The severity of pain in trigeminal neuralgia typically waxes and wanes and spontaneous remission is common. Frequency of attacks can vary from several times a day to a few times a month. Unfortunately, for most patients, the pain is generally progressive and the number and severity of attacks increase over time.