does trigeminal neuralgia in MS usually mean a definite pons lesions or brain stem lesions?

Here is My Question:
I have had MS for about a year and a half. I have developed many symptoms and it just won’t let up. My question is about trigeminal neuralgia. I have been having a severe shooting aching burning pain on and off in the right side of my face and I’m about 90% sure it’s trigeminal neuralgia. It is very typical of what I’m reading. I have an MRI scheduled next week. I was wondering, does trigeminal neuralgia in MS usually mean a definite pons lesions or brain stem lesions? Can any of the other lesions in the brain cause this pain? I haven’t had any brain stem lesions but I do have cortical and juxtacortical and spinal cord lesions. My highest spinal cord lesions is in C2. I also didn’t have any cerebellum lesions. Should I expect to have pons lesions now?

Answer:
Both Trigeminal neuralgia (TN) and atypical facial pain are common in MS patients. Trigeminal neuralgia is most often a paroxysmal (rapidly coming and going often multiple times a day), lancinating (like a knife or ice pick) pain in the jaw or maxillary region usually triggered by touch, chewing or talking.

Trigeminal neuralgia in MS patients can be due to vascular compression of the trigeminal nerve as it is exiting the brainstem, a demyelinating plaque of the trigeminal nerve exit zone or both. 
We can often see MS involvement of the brainstem in patients with trigeminal neuralgia, but only if high field (3 Tesla) magnets are used with the correct sequences. Typical MRI scans often do not clearly show the area involved by your MS that is causing the trigeminal neuralgia.

TN is very treatable so I hope you get relief soon.

Revere (Rip) Kinkel MD
Professor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego