Facial pain
A sudden, electric jolt of pain through your cheek or jaw. A burning sensation in your face that never seems to go away. Or intense pain during everyday activities like eating, talking, brushing your teeth, or touching your face.
Facial pain can have a major impact on your daily life. Sometimes the pain attacks are so severe that you try to avoid certain movements or touches. For others, the pain is constant, even when there is no clear trigger.
Facial pain is an umbrella term for various pain syndromes in the face, in which both peripheral nerves and brain networks involved in pain processing can play a role.
A major cause of neurological facial pain is a disturbance of the trigeminal nerve, the fifth cranial nerve.
Scientific research shows that chronic facial pain can be associated with changes in the interaction between brain regions involved in pain perception and pain regulation.
At BRAI3N, we use targeted neuromodulation to influence the activity of brain networks involved in the development and maintenance of facial pain.
With this, we aim to reduce the pain and its impact on your daily life.
In addition to non-invasive neuromodulation, there are also invasive stimulation techniques that can be used for selected patients with treatment-resistant facial pain.
Within the expertise of BRAI3N, Prof. Dr. Jean-Pierre Van Buyten, an internationally experienced specialist in pain therapy and invasive neuromodulation, holds a prominent position.
What is it?
What is facial pain?
Facial pain is pain experienced in one or more parts of the face.
The pain can occur in the cheeks, jaws, around the eyes, near the nose, in the mouth, or around the ear.
Depending on the underlying cause, the pain can feel very different:
- Sudden, electric-like jolts of pain.
- Sharp or stabbing pain.
- A constant burning sensation.
- A dull or aching pain.
- Increased sensitivity to touch.
- Pain when chewing, talking, or brushing teeth.
- A combination of constant pain and sudden flare-ups.
Some forms of facial pain are caused by demonstrable damage to or irritation of a nerve.
In other patients, the mechanisms are more complex, and changes in how the brain processes and regulates pain signals also play a role.
The trigeminal nerve: a key nerve in facial pain
The trigeminal nerve is the fifth cranial nerve and is responsible for a large part of the sensory perception in the face.
This nerve consists of three main branches:
V1 — Ophthalmic nerve
This branch is responsible for, among other things, sensory perception of the forehead, the area around the eye, and the upper part of the nose.
V2 — Maxillary nerve
This branch is involved in sensation in the cheek, upper lip, upper jaw, and upper teeth.
V3 — Mandibular nerve
This branch provides sensory perception for the lower jaw, lower lip, and lower teeth, among other areas.
In addition, this nerve branch contains motor fibers for the muscles of mastication.
The trigeminal nerve is connected to nerve nuclei in the brainstem and to various brain regions involved in pain processing.
When this nerve becomes damaged or abnormally active, intense pain signals can occur.
What types of facial pain are there?
1. Trigeminal neuralgia
Trigeminal neuralgia, also known astic douloureux, is a neurological condition characterized by sudden, extremely intense shooting pains in the face.
The pain is often described as an electric shock or a sharp, stabbing sensation.
An attack usually lasts from a few seconds to about two minutes.
Often, only one side of the face is affected.
The pain can be triggered by simple actions such as touching the face, brushing teeth, eating, talking, or a cold breeze.
In classic trigeminal neuralgia, a portion of the trigeminal nerve is compressed by a blood vessel, which can cause changes in the insulating layer around the nerve fibers.
This allows nerve signals to be transmitted uncontrollably more easily.
There are also other forms of trigeminal neuralgia, such as those where multiple sclerosis plays a role or where no clear cause is found.
Some patients experience a more constant background pain in addition to the short bursts of pain.
2. Trigeminal neuropathy
Trigeminal neuropathy involves damage to or impairment of the trigeminal nerve.
This can occur, for example, following trauma, a dental procedure, surgery, or an infection.
Unlike typical trigeminal neuralgia, the pain associated with trigeminal neuropathy is often constant.
Patients may describe:
- A burning or aching pain.
- Tingling or numbness.
- Altered sensation when touched.
- Pain from light stimuli that would not normally cause pain.
- Sudden sharp pains on top of a constant background pain.
When a damaged nerve transmits less normal sensory information, an abnormal pain sensation can occur simultaneously.
This helps explain why pain and sensory loss sometimes occur together.
3. Postherpetic neuralgia
Postherpetic neuralgia is nerve pain that persists after an infection with the varicella-zoster virus, which causes shingles.
When the trigeminal nerve is involved, the pain can be located in the face.
The pain is often described as burning, stabbing, or electric. Touching the skin can also become extremely painful.
In the event of a new shingles infection around the eye, prompt medical evaluation is important due to the risk of eye damage.
4. Persistent idiopathic facial pain
In some patients, facial pain persists for an extended period without a clear nerve injury or other physical cause being identified.
This is calledpersistent idiopathic facial pain.
The pain is often present daily and is usually described as deep, aching, throbbing, or burning.
The pain does not necessarily follow the path of one specific nerve branch.
The absence of a clearly visible injury does not mean the pain is imagined.
The processing of pain signals is a complex neurological process. In cases of persistent pain, changes in the interaction between peripheral nerves, the brainstem, and central pain-regulating systems may play a role.
5. Burning Mouth Syndrome
Burning mouth syndrome causes a persistent burning or painful sensation in the mouth, often in the tongue, lips, or palate.
Some patients also experience an altered sense of taste or a dry mouth.
When local causes have been ruled out, changes in sensory processing and nerve function may contribute to these symptoms.
Here, too, neuromodulation and the involved brain networks are being scientifically investigated.
6. Jaw-related facial pain
Not all facial pain is neuropathic.
Problems with the temporomandibular joint or the muscles of mastication can also cause pain in the cheeks, temples, jaws, or around the ear.
With temporomandibular disorder (TMD), symptoms can occur when chewing, yawning, or moving the lower jaw.
Dental conditions can also cause facial pain.
That is why it is important, in the case of persistent symptoms, to first determine whether there is a dental, jaw-related, or other local cause.
What happens in the brain during facial pain?
Facial pain does not originate solely at the site where the pain is felt.
The final pain experience is created by the processing of signals in various parts of the nervous system.
An important pathway is thetrigeminal pain system.
Pain signals from the face are transmitted via the trigeminal nerve to the brainstem.
From there, signals are relayed to the thalamus and various areas of the cerebral cortex.
These systems help determine where the pain is located, how intensely it is experienced, and how the nervous system reacts to it.
Various brain regions play a role in this process.
The thalamus: processing and relaying pain signals
The thalamus serves as a key relay station between the brainstem and the cerebral cortex.
It helps transmit sensory information, including pain signals, to various brain regions.
The somatosensory cortex: where and how much does it hurt?
The somatosensory cortex is involved in identifying the location and intensity of pain.
Changes in the functioning of these areas can contribute to an altered sensitivity to touch or other stimuli.
The anterior cingulate cortex: the impact of pain
The anterior cingulate cortex (ACC) is involved in various aspects of pain processing, including attention, motivation, and the emotional significance of pain.
Chronic facial pain can be associated with changes in the activity and functional connections of this area.
The insula: physical sensations and pain perception
The insula helps process signals from the body and plays a role in the conscious experience of pain.
This area works closely with other brain networks involved in attention and emotion regulation.
The prefrontal cortex: regulation and control
The prefrontal cortex is involved in cognitive control and influencing pain experiences.
This area is connected to systems that can amplify or suppress pain signals.
Why can facial pain become chronic?
Normally, the nervous system has various mechanisms that regulate the transmission and processing of pain signals.
In cases of long-term neuropathic pain, these systems can change.
Some nerve cells become easier to activate, while systems that help suppress pain may function less efficiently.
As a result, pain signals can be amplified or persist, even when the original cause has diminished.
This process is linked to, among other things,central sensitization.
Research bySven VannesteandDirk De Ridderdescribes how an altered balance between pain processing and pain suppression can contribute to chronic pain.
This network approach is also relevant for understanding and treating chronic facial pain.
Read more on our page aboutchronic pain.
Is facial pain the same as migraine or headache?
Facial pain,headacheandmigrainecan activate partially overlapping pain systems.
However, they are distinct conditions.
Trigeminal neuralgia is typically characterized by short, electric-like jolts of pain, often triggered by touch.
Migraines generally involve longer attacks that may be accompanied by nausea and sensitivity to light and sound.
Cluster headaches involve very intense attacks around the eye, often combined with tearing, a red eye, or a stuffy nose.
Because these conditions require different treatments, a thorough clinical assessment is important.
How to treat
Treatment that addresses the root cause of the pain
Facial pain can have various causes. Therefore, effective treatment begins with identifying the pain pattern and investigating potential underlying conditions.
For trigeminal neuralgia, medications such as carbamazepine or oxcarbazepine are typically used first.
When medication is ineffective or poorly tolerated, neurosurgical treatment may be considered for select patients.
In cases of classic trigeminal neuralgia with demonstrable neurovascular compression, for example, microvascular decompression may be indicated.
Other forms of facial pain may require different treatments, such as specialized pain medication, dental care, jaw therapy, or multidisciplinary pain management.
When pain is not sufficiently controlled, neuromodulation can offer an additional treatment option. Both non-invasive and invasive techniques can play a role here.
Non-invasive neuromodulation: influencing brain networks involved in pain
Non-invasive neuromodulation uses electrical or magnetic stimulation to influence the activity of affected nerves and brain networks without the need for surgery.
For facial pain, various brain regions can serve as targets for treatment.
Treatment does not necessarily have to focus exclusively on the nerve where the pain originates.
Brain regions involved in pain processing and pain suppression can also be important.
At BRAI3N, we use targeted neuromodulation to influence the activity of these pain-processing brain networks.Our goal is to reduce the intensity of facial pain and improve daily functioning.
Depending on the pain pattern, various non-invasive techniques can be used, including transcranial electrical stimulation (tES) and transcranial magnetic stimulation (TMS).
Why is motor cortex stimulation effective?
A key target for neuropathic facial pain is the primary motor cortex.
Although this brain region is primarily known for its role in movement, it is also connected to systems that regulate pain signals.
Stimulating the motor cortex can induce changes in the activity of the thalamus, brainstem, and other pain-regulating networks.
This can influence how pain signals are processed.
Scientific studies show that this approach can provide pain relief for certain patients with trigeminal neuralgia, trigeminal neuropathy, and other forms of chronic facial pain.
The prefrontal cortex and other pain-processing networks are also being investigated as potential targets.
Invasive neuromodulation for refractory facial pain
When facial pain is particularly severe and does not respond sufficiently to medication or non-invasive neuromodulation, for selected patients,invasive neuromodulationmay also be considered.
In invasive neuromodulation, electrodes are surgically placed near specific nerves or in certain parts of the nervous system.
We use electrical impulses to attempt to influence the transmission and processing of pain signals.
Depending on the type of facial pain, various techniques may be considered.
1. Peripheral nerve stimulation
In peripheral nerve stimulation, electrodes are placed in the vicinity of a nerve involved in the pain.
For facial pain, for example, branches of the trigeminal nerve can be stimulated.
The goal is to influence the abnormal pain signals originating from the affected area.
2. Stimulation of the Gasserian ganglion
The Gasserian ganglion is a nerve cluster containing the cell bodies of a large portion of the sensory nerve cells of the trigeminal nerve.
For certain forms of refractory trigeminal neuropathy, electrical stimulation of this ganglion can be used.
This is used to attempt to influence the transmission of pain signals from the face to the central nervous system.
3. Invasive motor cortex stimulation
In motor cortex stimulation, electrodes are surgically placed on or above the motor cortex.
This technique is performed in specialized centers for certain forms of severe, refractory neuropathic pain.
Through connections with other brain regions, the stimulation can influence central pain-regulating systems.
4. Deep brain stimulation
In deep brain stimulation (deep brain stimulation, DBS), electrodes are placed in specific deep-seated brain regions.
Researchers have studied various targets for this, including parts of the thalamus, the anterior cingulate cortex, and the periaqueductal gray in the brainstem.
This treatment is only considered for carefully selected patients within specialized neurosurgical care.
The expertise of Prof. Jean-Pierre Van Buyten, MD, PhD
Prof. Jean-Pierre Van Buyten, MD, PhD, is an internationally recognized expert in pain therapy and invasive neuromodulation, with particular expertise in the treatment of refractory facial pain.
He has made significant contributions to the development and scientific evaluation of various invasive neuromodulation techniques.
In a 2017 scientific publication, he and his colleagues investigated the results of stimulating the Gasserian ganglion in patients with severe, refractory trigeminal neuropathy.
Long-term pain relief was observed in a portion of the patients.
He has also published on invasive neurostimulation for facial pain and headache, as well as peripheral nerve stimulation for post-traumatic neuralgia.
His expertise is a valuable addition to the broader neuromodulation knowledge within BRAI3N.
Read more about Prof. Jean-Pierre Van Buyten, MD, PhD, and his expertise at BRAI3N.
What is the role of invasive neuromodulation in treatment?
Not every patient with facial pain requires an invasive treatment.
The choice between non-invasive and invasive neuromodulation depends on several factors:
- The specific diagnosis and the underlying cause.
- The distinction between paroxysmal and continuous pain.
- The severity and duration of the symptoms.
- The results of previous treatments.
- Any sensory disturbances or demonstrable nerve damage.
- Overall health and potential risks of a procedure.
For classic trigeminal neuralgia with clear neurovascular compression, microvascular decompression may be a recommended neurosurgical treatment, for example.
For certain forms of trigeminal neuropathy, nerve stimulation can be an interesting option.
Invasive neuromodulation always requires a specialized assessment, as the placement of electrodes can carry risks, including infection, technical complications, and sometimes neurological side effects.
The various treatment techniques are therefore not interchangeable solutions, but are part of a broader, specialized approach to facial pain.
What does scientific research show?
Scientific knowledge regarding neuromodulation for facial pain has expanded significantly in recent years.
Electrical stimulation for trigeminal neuralgia
In 2014, Hagenacker and colleagues investigated transcranial direct current stimulation (tDCS) in ten patients with classic trigeminal neuralgia.
After active stimulation, a significant reduction in pain intensity was observed compared to placebo.
The frequency of pain attacks did not change significantly.
Patients with short, paroxysmal bursts of pain without constant background pain seemed to benefit the most.
Neuromodulation affects involved brain networks
In 2022, Babakhani and colleagues studied six patients with refractory trigeminal neuralgia.
After five treatment sessions with targeted tDCS, the patients reported a reduction in pain and associated limitations.
Functional MRI also showed changes in the activity of various brain regions, including the somatosensory cortex, thalamus, basal ganglia, and anterior cingulate cortex.
This supports the premise that neuromodulation can influence multiple components of the pain network.
Invasive neuromodulation for trigeminal neuropathy
In 2017, Kustermans, Van Buyten, and colleagues published a study of 22 patients with refractory trigeminal neuropathy.
The researchers evaluated the results of stimulation of the Gasserian ganglion.
In approximately 77% of the patients, the trial stimulation was successful.
After 24 months, 44% of the patients reported satisfactory long-term pain relief.
The study also showed that complications occurred relatively frequently. This highlights the importance of careful patient selection and specialist follow-up.
International systematic reviews
A 2018 systematic review compiled fourteen controlled studies with a total of 228 patients suffering from various forms of chronic orofacial pain.
Favorable results regarding pain intensity were found with several non-invasive stimulation protocols.
A new systematic review from 2026 examined 57 studies on central neuromodulation for facial pain.
This research investigated both non-invasive techniques and invasive treatments, including motor cortex stimulation and deep brain stimulation.
The results show that various components of the central pain network can be therapeutically influenced.
The magnitude and duration of the effect vary depending on the condition, the stimulation technique, and the individual patient.
How does BRAI3N approach facial pain?
At BRAI3N, we start by looking at the involved pain networks and the individual's pattern of symptoms.
We look not only at where the pain is located, but also at how the pain originates and which mechanisms may be contributing to its persistence.
For one patient, it may involve sudden, electric-like jolts of pain. For another, there may be a persistent burning or aching sensation.
Sensory disturbances, hypersensitivity to touch, sleep quality, and the impact of pain on daily functioning also play a role.
Drawing on our expertise in neuromodulation, we apply targeted treatments to influence the activity of the involved pain networks.
In addition, we consider the possibilities of invasive neuromodulation when the symptom pattern and previous treatments warrant it.
The expertise of professionals such as Prof. Dr. Jean-Pierre Van Buyten helps us approach these treatment options from a broad, scientifically grounded perspective.
The BRAI3N treatment process
1. Assessment
During an initial evaluation, we will discuss your pain symptoms, medical history, and any previous examinations or treatments.
We pay attention to factors such as the location of the pain, the distinction between episodic and continuous symptoms, sensory changes, and the impact on daily functioning.
Existing neurological imaging and previous dental or neurosurgical examinations may also be relevant.
AnqEEG measurement and analysisprovides additional information about electrical brain activity but is not a standalone diagnostic test for facial pain and does not replace a neurological examination or MRI.
2. Targeted treatment
Based on the clinical evaluation, we determine which symptoms and affected pain networks should be prioritized.
When neuromodulation is indicated, we choose an approach that aligns with the specific pain pattern and the available treatment options.
For selected patients, a specialized assessment for invasive neuromodulation may also be relevant.
3. Stabilization
During the treatment process, we monitor how symptoms evolve.
We look at factors including:
- The intensity of the pain.
- The frequency and duration of any pain attacks.
- The presence of constant background pain.
- Sensitivity to touch.
- The use of pain medication.
- The impact of pain on sleep and daily activities.
Based on these results, the treatment can be adjusted.
4. Maintenance
When the pain decreases, we look at how to best maintain this improvement.
Depending on the situation, continued neurological follow-up, medication, multidisciplinary pain care, or additional treatments may remain important.
Not every patient requires the same treatment or a maintenance plan.
Does facial pain continue to affect your daily life?
Do you experience regular, intense shooting pains in your face, persistent burning pain, or facial pain that has not responded sufficiently to previous treatments?
If so, it may be worthwhile to explore which neuromodulation treatment could be relevant for your situation.
BRAI3N offers a unique combination of science and care.
Through close collaboration between neuroscientists and clinicians, scientific insights are carefully translated into clinical practice.
Contact us for a no-obligation consultation or to schedule an appointment
Scientific Background
Neuromodulation of the central nervous system for facial pain
Yuen J, Loh A, Darmani G, Sarica C, Patel N, Lozano AM, Hodaie M.Neurotherapeutics. 2026;23(3).
Non-invasive brain stimulation for neuropathic orofacial pain: a mini-review
Lin X, Niu X, Hu T, Zhang J, Diao Y, Li J, et al.Frontiers in Pain Research. 2026;7:1746977.
Non-invasive brain stimulation in chronic orofacial pain: a systematic review
Herrero Babiloni A, Guay S, Nixdorf DR, de Beaumont L, Lavigne G.Journal of Pain Research. 2018;11:1445–1457.
Hagenacker T, Bude V, Naegel S, Holle D, Katsarava Z, Diener HC, Obermann M.The Journal of Headache and Pain. 2014;15:78.
Babakhani B, Hoseini Tabatabaei N, Elisevich K, Sadeghbeigi N, Barzegar M, Mohammadi Mobarakeh N, et al.Frontiers in Human Neuroscience. 2022;16:848347.
The Treatment of Orofacial Pain by Using Transcranial Direct Current Stimulation
Fricová J, Englerová K, Nedvídek J, Rokyta R.Physiological Research. 2019;68(Suppl 3)–S372.
Transcranial direct current stimulation efficacy in trigeminal neuralgia
Fasilis T, Gatzonis S, Patrikelis P, Korfias S, Alexoudi A.World Journal of Clinical Cases. 2024;12(5):1036–1038.
Stimulation of the Gasserian ganglion in the treatment of refractory trigeminal neuropathy
Kustermans L, Van Buyten JP, Smet I, Coucke W, Politis C.Journal of Cranio-Maxillofacial Surgery. 2017;45(1):39–46.
Invasive neurostimulation in facial pain and headache syndromes
Van Buyten JP, Linderoth B.European Journal of Pain Supplements. 2011;5(Suppl 2):409–421.
Trigeminal Ganglion Stimulation
Van Buyten JP.Progress in Neurological Surgery. 2015;29:76–82.
Van Buyten JP, Smet I, Devos M, Vanquathem NE.Pain Practice. 2019;19(4):435–439.
Trigeminal neuralgia: An overview from pathophysiology to pharmacological treatments
Gambeta E, Chichorro JG, Zamponi GW.Molecular Pain. 2020;16:1744806920901890.
Motor Cortex Stimulation for Deafferentation Pain
Hussein AE, Esfahani DR, Moisak GI, Rzaev JA, Slavin KV.Current Pain and Headache Reports. 2018;22:45.
Chronic pain as a brain imbalance between pain input and pain suppression
Vanneste S, De Ridder D.Brain Communications. 2021;3(1).
Broecker F, Vanneste S.Sensory Neuroscience. 2026;2(1).
Non-Invasive Management of Head and Neck Neuralgia: A Literature Review
Borghare PT, Methwani DA, Tidke M, Nasre Y, Kumar T.Cureus. 2024;16(8).
European Academy of Neurology guideline on trigeminal neuralgia
Bendtsen L, Zakrzewska JM, Abbott J, et al.European Journal of Neurology. 2019;26(6):831–849.
Authors: Prof. Dr. Sven Vanneste, Prof. Dr. Dirk De Ridder and Jan Ost - 23/10/2026
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Chronic Pain and Fatigue Syndromes
Chronic pain and fatigue are often difficult to treat with conventional methods, especially when there is no obvious physical cause.
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Sleep and energy management are essential for brain function. Problems in these areas can lead to severe tiredness and difficulty concentrating.
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