Reviewed 20 August 2026 against current peer-reviewed epidemiological evidence and UK clinical guidance.
By Aneeta Prem MBE
Trigeminal neuralgia affects women more often than men. That has been recognised for years, but a major 2026 systematic review gives us a clearer picture of the evidence — and of what researchers still do not know.
For me, this is not an abstract question. I live with bilateral trigeminal neuralgia and lead TNA UK. I see the importance of separating what patients experience from what research has actually established.
What the 2026 evidence found
A systematic review and meta-regression published in the Journal of Clinical Neurology in January 2026 examined 17 eligible studies from 1945 to 2024. Together they covered more than 170 million participants and 109,070 people diagnosed with trigeminal neuralgia.
The researchers found that pooled incidence and prevalence estimates tended to be higher in women than in men. The pooled incidence estimate was 43.84 per 100,000 person-years in women and 21.85 in men. The pooled annual prevalence estimate was also higher in women.
But there is an important qualification: the authors judged certainty around several subgroup differences to be low, and the studies varied substantially in design, populations and diagnostic methods.
So the responsible conclusion is not that we have solved the sex difference. It is that the available evidence consistently points towards a higher burden in women and that the reasons deserve better study.
What we do not yet know
The evidence does not establish why women are affected more often.
It does not prove that hormones, menopause or any single biological factor explains the difference. Those are research questions, not settled facts.
That distinction matters. Women with facial pain should not be given speculative explanations simply because medicine has not yet answered the question.
Diagnosis can begin in the wrong place
Trigeminal neuralgia pain is often felt in the jaw, teeth or gums. NHS guidance notes that many people therefore see a dentist before a GP and that diagnosis involves ruling out dental and other causes of facial pain.
That does not mean dental assessment is a mistake. Tooth and jaw pain are common, and clinicians have to rule out common causes. The problem comes when severe, recurrent or electric-shock-like facial pain continues despite no clear dental explanation and the possibility of a neurological cause is not considered.
MRI is often used as part of specialist assessment and may help identify causes including vascular compression, multiple sclerosis or, less commonly, other structural problems.
Treatment is not one-size-fits-all
NICE recommends carbamazepine as initial treatment for trigeminal neuralgia in non-specialist settings. If it is ineffective, not tolerated or contraindicated, NICE advises seeking specialist advice and considering early referral.
For some patients, medicines provide useful control. Others struggle with side effects or inadequate relief. Surgical and other procedures may then be discussed with specialists, depending on the cause of the pain, imaging, health, treatment history and individual preferences.
Patient information should make those trade-offs understandable rather than presenting one treatment as right for everyone.
Why a women’s-health lens still matters
A condition does not have to be reproductive or hormonal to belong in conversations about women’s health.
If women appear to carry a greater burden of trigeminal neuralgia, health systems should ask whether diagnosis, treatment tolerability, work, caring responsibilities and access to specialist services affect them differently.
Those questions need sex-stratified research rather than assumptions.
Patient evidence matters — but it must be labelled correctly
Patient surveys can show how people experience diagnosis, medication, surgery, isolation and access to care. They are valuable because clinical datasets often miss those parts of life.
But a charity survey is not a population prevalence study. When TNA UK publishes patient-experience findings, the sample, denominator and limitations must remain clear. Patient evidence is strongest when it is presented for what it is rather than stretched beyond what the data can support.
What needs to happen next
- More sex-stratified epidemiological and treatment research.
- Better understanding of why women appear to be affected more often.
- Earlier recognition of neurological facial pain when dental causes have been excluded.
- Clear referral routes when first-line treatment is ineffective or poorly tolerated.
- Patient-experience evidence reported alongside, not in place of, clinical research.
Final word
The evidence now gives us a firmer basis for saying that trigeminal neuralgia appears to affect women more often than men. It does not yet tell us why.
That uncertainty should be a reason for better research, not a licence for speculation.
Sources and further reading
- Jeong YD et al. Global Incidence and Prevalence of Trigeminal Neuralgia, 1945–2024
- NHS: Trigeminal neuralgia
- NHS: Trigeminal neuralgia diagnosis
- NICE: Neuropathic pain guidance