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While the exact mechanism of pain is unknown, it is thought that many cases of trigeminal neuralgia (TN) results from irritation or damage to the trigeminal nerve. The irritation leads to loss of covering or insulation of the nerve fibers (demyelination), which in turn become hyperexcitable and begin to fire in an erratic and disorganized manner. The most common cause of nerve irritation is compression of the trigeminal nerve by adjacent major arteries (often the superior cerebellar artery) or veins as they exit the brainstem.

There are several possible causes of trigeminal neuralgia. Primary trigeminal neuralgia, also referred to as idiopathic trigeminal neuralgia, is caused by a blood vessel (usually the superior cerebellar artery) compressing the trigeminal nerve as it exits from the brainstem. Other causes of trigeminal neuralgia are usually secondary to another underlying medical condition and may include:

• Multiple Sclerosis - a chronic autoimmune disorder caused by the destruction (demyelination) of the myelin sheath covering the nerve fibers in the brain and spinal cord. Multiple sclerosis may also result in demyelination of one or more branches of the trigeminal nerve and lead to trigeminal neuralgia.

• In rare cases, a tumor compressing the trigeminal nerve may also cause trigeminal neuralgia.

It should be noted that it is important to distinguish trigeminal neuralgia from trigeminal neuropathy, which refers to a pain syndrome resulting from a more significant injury to the trigeminal nerve. Frequent causes of trigeminal neuropathy are surgical procedures involving the teeth and sinuses as well as trauma or infections of the face and head.