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The cause of tic douloureux is unknown. There are a number of theories as to why the trigeminal nerve is affected.

• The most commonly accepted theory is compression of the trigeminal nerve, usually by a blood vessel, causing it to become irritated. This irritation causes the outer covering of the nerve (the myelin sheath) to erode over time. The irritated nerve then becomes more excitable and erratically fires pain impulses.
  
  
• Tumors and bony abnormalities of the skull may also press on and irritate the trigeminal nerve.
  
  
• Trauma, infections, and multiple sclerosis can also cause damage to the trigeminal nerve.

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