Specialist article: jaw and head
Trigeminal painThe great sensory nerve of the face
You have pain in your cheek, jaw or temple, and the trigeminal nerve has been mentioned? Here you will find out where the trigeminal nerve runs, how trigeminal neuralgia can be recognised and why it should be treated neurologically. You will also learn what the chewing muscles, the neck and the basic functions of breathing, swallowing and head balance have to do with many other types of facial pain.
Does this sound familiar?
Your face hurts, and everyone is talking about the trigeminal nerve?
What applies to you?
Tap whatever applies to you.
The first five points fit pain in which the chewing muscles, jaw joint and neck are involved. Here it is worth looking at breathing, swallowing and head balance. The last point describes the typical picture of trigeminal neuralgia. It belongs first in the hands of a neurologist.
How to recognise neuralgiaJaw, chewing muscles and neckThe key points at a glance
- The trigeminal nerve is the fifth cranial nerve and the great sensory nerve of the face. It reports touch, pressure, temperature and pain from the skin, teeth, mouth and nose, and controls the chewing muscles.
- Trigeminal neuralgia, with short, sudden attacks, is a neurological condition. It should be assessed and treated by a doctor; the training does not replace this.
- Many other types of facial pain have to do with the chewing muscles, jaw joint and neck. In our view, what usually lies at the beginning is a disrupted pattern of breathing, swallowing and head balance, and patterns can be trained.
Video
The trigeminal nerve: where it runs and why it can hurt
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Anatomy
Nervus trigeminus: the triplet nerve of the face
Twelve pairs of nerves emerge directly from the brain. The fifth of them supplies almost the entire face.
The nervus trigeminus is called the “triplet nerve” in German because it divides into three large branches. It is the largest sensory cranial nerve of the head. Its fibres report touch, pressure, temperature and pain from the forehead, cheeks, lips, teeth, gums, palate, nasal mucosa and jaw joint. In addition, it has a motor component. This controls the chewing muscles, which raise, hold and move the lower jaw.
In everyday language, the trigeminal nerve is often called the facial nerve. Anatomically, that is a different nerve. The nervus facialis, the seventh cranial nerve, moves the muscles of facial expression and, with them, the lips. The trigeminal nerve senses; the facial nerve moves the facial expression. So anyone searching for “facial nerve” and pain usually means the trigeminal nerve.
A look at the chewing muscles shows how much force the trigeminal nerve controls. The temporal muscle fans out over the temple, and the masticatory muscle, the masseter, stretches from the cheekbone arch to the angle of the jaw. Both are supplied by the third branch.
From these muscles and from the tissues that hold the teeth, signals about length and pressure travel to a special nucleus in the brainstem. Its nerve cells are the only primary sensory neurons whose cell bodies lie within the central nervous system itself1. This allows bite force and jaw position to be regulated finely and quickly.
Sensation
Where does the trigeminal nerve run? A sensor for mouth, teeth and nose
The trigeminal nerve is not just a pain cable. For most of the day, it reports entirely everyday things.
The nerve arises from the brainstem and forms a nerve ganglion at the base of the skull, the trigeminal ganglion. From there, its three branches pass through small openings in the bone above the eye, below the eye and in the lower jaw into the skin and mucous membranes. The lips, the tip of the tongue and the front of the palate are among the most finely sensitive regions of the body. Every bite, every swallow and every breath through the nose produces signals that travel via the trigeminal nerve to the brainstem.
The trigeminal nerve is not a pain cable. It is the mouth’s most important sensor.It reports contact, pressure and airflow, and the brain aligns the tongue, jaw and lips accordingly.
A study of 44 healthy people shows how much the nose is perceived via this nerve. Whether the nose felt clear was not related to the measured resistance. What counted most was the cooling of the mucous membrane by the incoming air, a sensation provided by trigeminal fibres2. With mouth breathing, this stimulus is missing. More on the nose in the article Deviated nasal septum.
Trigeminal neuralgia
Trigeminal neuralgia: sudden, brief and intense
When people talk about trigeminal pain, many think of neuralgia first. It is a distinct, clearly described condition.
Typical features are very intense, stabbing attacks of pain in the face that last only briefly and are triggered by light stimuli3. Those affected describe them as being like an electric shock. Triggers can include touch, brushing teeth, speaking, chewing or a draught. Between attacks there is often calm; in some of those affected, a dull background pain remains.
had attacks only in the second or third branch, i.e. in the cheek, jaw or teeth, studied in 158 patients at a specialist clinic4
had persistent pain in addition to the attacks4
was the mean age at onset; 60% of those affected were women4
The specialist societies distinguish three forms5. In the classical form, a blood vessel presses on the nerve root and alters it. In the secondary form, another condition lies behind it, such as multiple sclerosis or a tumour. If no cause is found, it is called idiopathic. Because the forms cannot be reliably distinguished on the basis of symptoms alone, a special MRI scan is part of the diagnostic work-up6.
Sudden attacks of pain in the face should be investigated and treated by a neurologist. According to the European guideline, carbamazepine and oxcarbazepine are the first-choice medications. If they are not sufficient or are poorly tolerated, surgery may be considered6. FaceFormer training is not a treatment for trigeminal neuralgia. Never stop prescribed medication on your own.
Telling them apart
Facial pain: not every pain is the nerve
Neuralgia is rare. Many pains in the cheek, jaw and temple have a different character.
In a Dutch analysis of general practice data, the forms of facial pain studied there together occurred as new cases in 38.7 per 100,000 people per year. Trigeminal neuralgia was one of the most common among them7. The authors describe facial pain of this kind as relatively rare. Pain in the face overall, on the other hand, is common, as a large study from the USA shows.
of initially symptom-free adults reported facial pain per year, observed in 3,258 people in the US study OPPERA8
developed a medically confirmed craniomandibular dysfunction (TMD) with pain per year, i.e. symptoms in the chewing muscles and jaw joint8
Trigeminal neuralgia
- Short attacks, often only seconds
- Stabbing, electric, shooting
- Triggered by light touch, speaking or brushing teeth
- Usually one-sided, in the area of one or two branches
Muscle and jaw joint pain
- Lasts hours to days
- Dull, pressing or dragging
- Worse with chewing, clenching, grinding or prolonged speaking
- Often together with neck pain or headaches
This comparison does not replace an examination. It helps you organise your observations for the conversation with your doctor.
Because the pain is often located in the teeth and jaw, many people with neuralgia go to the dentist first. At a clinic in Baghdad, this was the case for 88 of 104 patients. The most common measure was a tooth extraction, and around two thirds did not respond to the dental treatment9. You should also have the following signs checked promptly.
Numbness in the face
An area feels persistently numb or furry.
New deficits
Double vision, a drooping corner of the mouth, or hearing or speech problems appear.
Blisters or rash
Burning pain with a skin rash, for example with shingles on the face.
Fever or swelling
Pain with fever or swelling at a tooth, the cheek or a sinus.
Toothache with no findings
A tooth looks healthy and still hurts in sudden, sharp bursts.
New, severe persistent pain
A pain that is new, severe and does not ease.
Jaw and chewing muscles
Trigeminal nerve and jaw: when the chewing muscles are on constant duty
The third branch does not only sense, it also moves. That makes it the nerve of the jaw.
Chewing muscles are built for short, powerful work. When you chew, swallow or briefly bite down, the teeth meet and then separate again. At rest, the rows of teeth are not in contact, the lips rest lightly together and the tongue lies against the palate. If short work turns into constant work, for example through clenching or grinding, the muscles, the tooth-supporting apparatus and the jaw joint report this via the trigeminal nerve.
The pattern deviates
Mouth breathing, a low-lying tongue or a forward head posture. This often starts early, for example with a dummy, bottle or thumb.
The body compensates
The chewing muscles, floor of the mouth and neck take on holding work they are not designed for. The nervous system stores this solution as a habitual pattern.
Structures adapt
Tooth wear, strain on the jaw joint, altered tension in the neck.
Complaints arise
Pain in the chewing muscles, temple, cheek or teeth, in other words in the area supplied by the trigeminal nerve. When it appears and how severe it is depends on the extent, the duration and the person’s age.
This is how we see the chain behind many kinds of facial pain. In our view, at the start there is usually not a diseased nerve, but a nerve that reliably reports what the muscles are doing. In muscle-related facial pain, painkillers and muscle relaxants dampen the signal or the tension. They do not clarify why the masticatory muscles are on permanent duty.
A bite splint holds the bite from the outside without guiding it and can continue to provoke the masticatory muscles to clench. The load can then shift to other muscles and joints. Trigeminal neuralgia is a different case; there, medication is the standard treatment according to the guideline. You can read about the jaw joint, bite splints and exercises in detail in the article Understanding TMD.
Neck
The trigeminal nerve and the neck: a shared relay station
People with facial pain often have a stiff neck as well. There is an anatomical basis for this.
Some of the trigeminal fibres run down through the brainstem into the upper cervical spinal cord. There they meet fibres of the upper cervical nerves. This region is called the trigeminocervical nucleus. According to a review, this convergence allows pain to be perceived as shifted between the neck and the face in both directions10.
However, being neighbours does not in itself mean transmission. What has been demonstrated is a dedicated reflex pathway. If a branch of the trigeminal nerve below the eye is stimulated, the sternocleidomastoid muscle in the neck responds after a short delay. A research group in Merano found this trigeminocervical reflex altered in 13 out of 15 people with chronic tension-type headache, but in only one out of 15 with the episodic form11.
Jaw and head also work together during movement. In twelve healthy adults, the head extended slightly at the start of the first jaw movement and held this position. The head movement usually began before the jaw movement12. In a measurement from Nagasaki, the sternocleidomastoid muscle became active on average 12.5 to 24.3 milliseconds before the head movement. The authors interpret this as a centrally pre-programmed interplay13.
Place two fingers on the side of your neck, just below the skull, and slowly open your mouth as far as feels comfortable. What do you notice?
The same proximity of face, jaw and neck also plays a role in ear noises. More on this in the article Tinnitus.
The triad
Why we look at breathing, swallowing and head balance
The trigeminal nerve reports what happens in the face. What happens there is determined by the three basic functions.
Breathing
With nasal breathing, the lips rest lightly together and the lower jaw hangs relaxed. With mouth breathing, it drops, the tongue and chewing muscles hold differently, and the trigeminal nerve lacks the stimulus of airflow in the nose.
Swallowing
You swallow many hundreds to a thousand times a day. In a mature swallow, the tongue lies against the palate, the teeth meet briefly and the chewing muscles release again straight away. If you press when swallowing, they work along every time.
Head balance
When the head is balanced over the body, the neck carries it with little effort. If it moves forward, in our view the lines of pull on the lower jaw and hyoid bone change, and both the chewing muscles and the neck do more holding work.
In our view, facial pain is often the end of such a chain, not its beginning. Whether an impaired basic function should be corrected is decided by the function itself, not by the complaint it has already caused. In our view, an improvement is then a common consequence, not the actual subject of the training. You can read how a mature swallow works in the article Swallowing and swallowing disorders.
Like a smoke detector in the kitchen
A smoke detector that goes off while you are cooking is not broken. It reliably reports what is happening at the cooker. If you only turn the detector down, nothing changes at the cooker. Things become quiet when there is less smoke. This is how we see the trigeminal nerve in many kinds of muscular facial pain. Neuralgia is different: there, the nerve itself is affected.
Research
What has been shown, and what hasn’t
We separate what has been studied from what we derive from function.
with predominantly muscle-related jaw pain were followed for 12 weeks at the University of Jena. Pain decreased in both training groups, but not in the group without training14
practised coordination exercises with the FaceFormer, followed a strengthening programme or did no training at all. The two training groups did not differ from each other14
This study is peer-reviewed and has a comparison group, but it has limitations. How the groups were formed is not described, the group without training was small, and two developers of the FaceFormer are co-authors. Observation lasted only 12 weeks. There is no study with the FaceFormer on trigeminal neuralgia, and we do not claim any effect there.
The absence of a study does not mean that the connection does not exist. It means that it has not been tested.We support independent studies without influencing how they are conducted or evaluated. All our own studies, together with their limitations, are listed on the page Studies and science.
Training
Calming the trigeminal nerve? Train the basic functions
A pattern does not change through insight, but through precise, frequent repetition.
People who clench their teeth often resolve to stop. In the next moment of concentration, the teeth are together again. Compensation patterns are stored sequences. The original programme has not been deleted, only overlaid, and it can be relearned. In FaceFormer training, you practise lip closure, nasal breathing, tongue reference position, swallowing and head balance simultaneously in one sequence, rather than individual muscles in isolation.
The FaceFormer sits in the oral vestibule, behind the lips and in front of the teeth. The tip of the tongue rests on the small ridge behind the upper front teeth, you breathe through your nose, and your head is upright.
In the basic exercise you press the lip wedge together with your lips, bite down briefly with your back teeth and swallow once. Then you relax, and your teeth come apart again. It is exactly this alternation between brief effort and letting go that the chewing muscles practise along the way.
From around week 6, the head balance rotation is added. You press the lip wedge and slowly turn your head to the side for six seconds until you feel the neck muscles, never into pain.
In this position you bite down briefly and swallow, then slowly turn back to the centre. In this way the exercise links the jaw, the tongue and the muscles that keep the head in balance.
- From day 1
Basic exercise
Three times a day with the FaceFormer ZERO; you increase the repetitions week by week.
- From around week 3
Pull exercise and night
The pull exercise is added. At night you wear the ZERO once you have mastered the basic exercise.
- After a few weeks
Switching to the ONE
During the day, you train with the FaceFormer ONE. It is the same size and shape as the ZERO, just made of firmer material.
- From around week 6
Head balance and breathing
The head balance rotation and the breathing exercise complement the basic training.
- 6 to 12 months
The pattern runs by itself
The exercise manual allows six to twelve months until the new sequences run without thinking, followed by maintenance training.
At the beginning, tired muscles or pressure on the teeth are common. If so, you pause briefly and continue with fewer repetitions. If you have an acute jaw lock with severe pain, talk to your doctor first. If you have trigeminal neuralgia and inserting the device or pressing triggers attacks, you pause and discuss how to proceed with your neurology practice. The free FaceFormer app guides you through the basic exercises; you will find all modules on the exercise pages.
Everyday life
Relieving the jaw in everyday life
For a few days, pay attention to where your teeth are when you are not eating. Your lips rest loosely together, your rows of teeth are not in contact, and the tip of your tongue rests against the palate.
When the teeth meet outside of chewing and swallowing, the chewing muscles are working. Many people only notice how often this happens during the day when they consciously pay attention to it.
Teeth apart, lips closed
At rest, the teeth do not touch. Lips loosely closed, tongue at the reference point, breathing through the nose.
Keep a pain diary
Note down the duration, type and triggers of your pain. Electric-shock-like attacks lasting seconds and pressure pain lasting hours are different findings, and your notes help with the diagnostic work-up.
Skip chewing gum
Constant chewing keeps the chewing muscles working and, in our view, disrupts the pattern you are building up anew.
Head balance at the screen
Adjust your screen and seat so that your head balances over your body and does not drift forwards.
Nasal breathing at night too
If your mouth is open at night, the lower jaw drops, and the tongue and chewing muscles hold differently. We do not recommend taping your mouth shut.
Do not change prescribed treatment on your own
You only change medication or an occlusal splint that has been prescribed for you in consultation with your practice. The training can be combined with them.
Questions
Frequently asked
Where does the trigeminal nerve run?
It originates at the brainstem, forms a nerve ganglion at the base of the skull and divides into three branches. The first runs to the forehead, eye and bridge of the nose, the second to the cheek, upper jaw, upper teeth and nasal mucosa, the third to the lower jaw, lower teeth, chin, front of the tongue and jaw joint. The third branch also controls the chewing muscles.
Is the trigeminal nerve the facial nerve?
Colloquially yes, anatomically no. The facial nerve in the strict sense is the nervus facialis, the seventh cranial nerve. It moves the facial expressions. The trigeminal nerve is responsible for sensation in the face and for the chewing muscles. Pain in the face is therefore transmitted via the trigeminal nerve.
What can you do about trigeminal pain?
First, distinguish between types. Electric-shock-like attacks lasting seconds, triggered by touch or speaking, point to trigeminal neuralgia and should be assessed and treated by a neurologist. Dull, pulling pain lasting hours often has to do with the chewing muscles, jaw joint and neck. That is where we come in, with the basic functions of breathing, swallowing and head balance.
Can the trigeminal nerve be irritated by muscle tension?
Tense chewing muscles and a stiff neck generate signals that travel via the trigeminal nerve and the upper cervical nerves into the same relay station in the brainstem. This is why pain can be felt as shifted between the neck and the face. The nerve itself is usually not damaged; it reports what the muscles are doing.
Is the trigeminal nerve inflamed when the face hurts?
In everyday language, “trigeminal inflammation” often refers to an irritated nerve. Pain in the area it supplies can have very different causes, such as teeth, sinuses, chewing muscles and jaw joint, shingles in the face, or neuralgia. Assessing this belongs in the hands of a doctor, especially if there is fever, a rash, swelling or numbness.
Can teeth irritate the trigeminal nerve?
The teeth in the upper jaw are supplied by the second branch, those in the lower jaw by the third. An inflamed tooth therefore hurts via the trigeminal nerve, and conversely neuralgia can feel like toothache. If the dentist finds nothing and the pain comes like a flash, a neurological assessment is the next step.
Are there exercises for trigeminal neuralgia?
We know of no exercise that treats trigeminal neuralgia, and we do not promise one either. It is treated with medication and, if necessary, surgically. If you also have complaints in the chewing muscles, jaw and neck, you can train the basic functions alongside this. If the training triggers attacks, pause and discuss this with your practice.
Which FaceFormer do I start with?
You start during the day with the FaceFormer ZERO made of softer material and switch to the ONE after a few weeks. At night you only wear the ZERO. Both are the same size and the same shape.
More articles from the knowledge section
Experiences on this topic
Where to go next
Sources
- Seki S, Enomoto A, Tanaka S (2026). The mesencephalic trigeminal neuron: electrophysiological insights into function and dysfunction. Frontiers in Cellular Neuroscience. DOI 10.3389/fncel.2026.1752701. Source
- Zhao K, Blacker K, Luo Y, Bryant B, Jiang J (2011). Perceiving nasal patency through mucosal cooling rather than air temperature or nasal resistance. PLoS One 6(10):e24618. PMID 22022361. Source
- Bendtsen L, Zakrzewska JM, Heinskou TB, Hodaie M, Leal PRL, Nurmikko T, Obermann M, Cruccu G, Maarbjerg S (2020). Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. The Lancet Neurology 19(9):784-796. PMID 32822636. Source
- Maarbjerg S, Gozalov A, Olesen J, Bendtsen L (2014). Trigeminal neuralgia: a prospective systematic study of clinical characteristics in 158 patients. Headache 54(10):1574-1582. PMID 25231219. Source
- Cruccu G, Finnerup NB, Jensen TS, Scholz J, Sindou M, Svensson P, Treede RD, Zakrzewska JM, Nurmikko T (2016). Trigeminal neuralgia: New classification and diagnostic grading for practice and research. Neurology 87(2):220-228. PMID 27306631. Source
- Bendtsen L, Zakrzewska JM, Abbott J et al. (2019). European Academy of Neurology guideline on trigeminal neuralgia. European Journal of Neurology 26(6):831-849. PMID 30860637. Source
- Koopman JS, Dieleman JP, Huygen FJ, de Mos M, Martin CG, Sturkenboom MC (2009). Incidence of facial pain in the general population. Pain 147(1-3):122-127. PMID 19783099. Source
- Slade GD, Ohrbach R, Greenspan JD, Fillingim RB et al. (2016). Painful Temporomandibular Disorder: Decade of Discovery from OPPERA Studies. Journal of Dental Research 95(10):1084-1092. PMID 27339423. Source
- Badran SA, Qasim AM, Alhamandi F, Shahadha AA, Alsamok AS, Al-Taie RH, Al-Juboori AA (2026). Diagnostic challenges of trigeminal neuralgia in dental settings: a retrospective study. BMC Neurology 26(1):253. PMID 41663983. Source
- Biondi DM (2005). Cervicogenic headache: a review of diagnostic and treatment strategies. The Journal of the American Osteopathic Association 105(4 Suppl 2):16S-22S. PMID 15928349. Source
- Nardone R, Tezzon F (2003). The trigemino-cervical reflex in tension-type headache. European Journal of Neurology 10(3):307-312. PMID 12752406. Source
- Eriksson PO, Häggman-Henrikson B, Nordh E, Zafar H (2000). Co-ordinated mandibular and head-neck movements during rhythmic jaw activities in man. Journal of Dental Research 79(6):1378-1384. PMID 10890716. Source
- Torisu T, Yamabe Y, Hashimoto N, Yoshimatsu T, Fujii H (2001). Head movement properties during voluntary rapid jaw movement in humans. Journal of Oral Rehabilitation 28(12):1144-1152. PMID 11874515. Source
- Kopp S, Berndsen K, Berndsen S, Ifert F, Langbein U (2004). Initiale Therapie myogener Befunde im kraniomandibulären System mit einem konfektionierten intra-/extraoralen Trainingsgerät. Manuelle Medizin 42(1):55-62. Source
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The free FaceFormer app guides you through the basic exercises, counts along and reminds you of your sessions. If you wish, a practice from the practitioner directory can support you.
FaceFormer ZERO + ONE
Both material hardnesses for getting started, day and night. The set for adults.
FaceFormer ZERO
The softer FaceFormer for getting started, for children and for the night.
FaceFormer ZERO Children’s Set
ZERO with hygiene box, plush bag and success book with stamp.
FaceFormer training aims to restore the physiological setting of the basic functions of breathing, swallowing and head balance, with lip closure and the tongue reference position, thereby creating the conditions under which symptoms can improve. It does not replace a medical assessment. You can find practitioners near you in the practitioner directory.
