Reviewed 7 October 2026 against the 2026 systematic review, current NHS information and NICE guidance.
By Aneeta Prem MBE
The NHS says trigeminal neuralgia affects more women than men. A large systematic review published in 2026 also reported higher pooled incidence and prevalence estimates in women. But the research needs to be read with more care than that headline suggests.
For me, this is not an abstract question. I live with bilateral trigeminal neuralgia and lead TNA UK. That makes it especially important to separate what patients notice and ask about from what research has actually established.
What the 2026 review found
The systematic review and meta-regression, published in the Journal of Clinical Neurology, 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 pooled incidence estimate was 43.84 per 100,000 person-years in women and 21.85 in men. Pooled prevalence estimates also tended to be higher in women.
Those figures should not be read as proof that women have twice the underlying risk. The studies were highly heterogeneous, the confidence intervals were wide, and the authors rated certainty around subgroup differences as low. In the meta-regression analysis, the difference by sex was not statistically significant.
So the careful conclusion is narrower: several epidemiological estimates are higher in women, and the NHS also describes TN as more common in women, but this review does not establish a definitive sex effect or explain why any difference exists.
What we do not yet know
The evidence does not establish why women may be diagnosed more often.
It does not prove that hormones, menopause or any single biological factor explains the pattern. Those are research questions, not settled facts.
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 can still be useful
The uncertainty in the epidemiology does not make sex-specific questions irrelevant.
Researchers can still ask whether diagnosis, treatment tolerability, work, caring responsibilities, pregnancy-related prescribing considerations or access to specialist services differ by sex. Those questions need properly designed, 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 investigation of whether the apparent female predominance is biological, diagnostic, demographic or a mixture of factors.
- 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
There are good reasons to study trigeminal neuralgia in women more closely. The NHS describes the condition as more common in women, and the 2026 review produced higher pooled estimates in women.
But the same review also tells us to be cautious: subgroup certainty was low and the sex difference was not statistically significant in meta-regression.
That uncertainty is not a weakness to hide. It is the reason better research is needed.
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