Not long ago, a middle-aged woman came to the pain clinic, and before she could sit down, she excitedly complained to me about her pain: “Last April, my left molar had a vague pain for no reason, and I didn’t care at first, but then it was never ending. At first I thought it was just a toothache and had a tooth pulled locally, but within a few days the pain started again, so I had another molar pulled, but after the two molars were pulled it was still a toothache ……” she said while pulling her finger away from the corner of her mouth to show me where the tooth was pulled, but at that moment she suddenly couldn’t speak, frowning and clenching her teeth with a A painful expression. She could only barely answer my questions by nodding and shaking her head. After careful analysis of her medical history, observation of painful episodes and a thorough neurological examination, I made a diagnosis of trigeminal neuralgia. The trigeminal nerve extends from the brain and divides into three branches. The first branch manages the sensation in the frontal and ocular areas on one side, while the second and third branches manage the sensation in the lower eyelid, paranasal, upper and lower lips, and upper and lower rows of teeth, respectively. The second and third branches in particular are the most common, so patients often feel severe pain on one side of their teeth, which is often misdiagnosed as toothache. Although the “diseased” tooth is removed, the nerve is still present, so the pain does not go away. Once trigeminal neuralgia occurs, it tends to recur, and the pain is severe and unbearable, seriously affecting the patient’s health, life and work. There are two causes of trigeminal neuralgia, one is due to inflammation, tumor, vascular and bone malformation in the area where the trigeminal nerve travels or in the vicinity, also known as secondary trigeminal neuralgia. The other type of trigeminal neuralgia cannot be found clinically and is called primary trigeminal neuralgia in medical science. Primary trigeminal neuralgia usually develops after the age of 40, with pain spreading from a point on the face, oral teeth or jaw, and expanding as the disease progresses. The pain is paroxysmal, like a cut, a pinprick or an electric shock, and starts and stops abruptly and lasts from a few seconds to several minutes. The pain can be triggered by talking, eating, brushing teeth, blowing in the wind, or even by lightly touching the lips, gums, or nose. For the treatment of trigeminal neuralgia, for secondary cases, the main treatment is to target the cause of the disease and remove the identified cause. For primary cases, the following three methods of treatment are generally adopted: first, medication, commonly used drug is carbamazepine, starting with a small dose, and then gradually increasing the amount until the pain is significantly relieved. The disadvantage is that it needs to be taken for a long time and the pain is prone to recur after stopping the medication. In addition, long-term use of carbamazepine can have side effects such as drowsiness and tinnitus. The second is the nerve block method, using anhydrous alcohol to destroy the corresponding trigeminal nerve or its branches to eliminate the pain. If the first two methods are ineffective, surgical treatment can also be considered, such as intracerebral trigeminal nerve decompression or nerve adhesion separation, or as a last resort, trigeminal nerve severance. Trigeminal neuralgia usually does not affect the patient’s life expectancy, but sometimes the treatment is not ideal, so the patient needs to cooperate well with the doctor to find the ideal way to relieve the pain.