Can Lyme Disease Cause Trigeminal Neuralgia? Rare Cases Reported

Trigeminal neuralgia causes sudden, severe facial pain
Published case reports have described it with Lyme neuroborreliosis and anaplasmosis
Tick-borne infections should be considered in patients with compatible symptoms

Can Lyme disease cause trigeminal neuralgia? Published case reports have described trigeminal neuralgia in patients with Lyme neuroborreliosis and Anaplasma phagocytophilum infection, although it remains an uncommon neurologic manifestation. Facial nerve palsy is a much more frequently recognized cranial neuropathy in Lyme disease. In the case discussed here, the authors favored PCR-confirmed Anaplasma phagocytophilum infection rather than active Lyme disease as the most likely explanation for the woman’s acute illness.^1-3

Trigeminal neuralgia is characterized by sudden, severe, electric shock-like facial pain affecting one or more branches of the trigeminal nerve. It most commonly affects one side of the face, although bilateral symptoms can occur.^1,4

Although most cases are unrelated to tick-borne infections, clinicians should consider Lyme disease, anaplasmosis, ehrlichiosis, and other neurologic conditions when evaluating severe facial pain accompanied by systemic symptoms after tick exposure.

A woman developed severe facial pain after a tick bite

According to the authors, the 80-year-old woman experienced a “sudden onset of severe, lancinating headache in the distribution of the fifth cranial nerve bilaterally.” She also reported intermittent fever reaching 102°F, fatigue, muscle aches, and joint pain.¹

Two months earlier, she had completed a 2-week course of doxycycline for presumed Lyme disease after a tick bite and a rash on her torso. She later found another non-engorged tick that was easily removed.

Her neurologic examination was consistent with trigeminal neuralgia. Trigeminal neuralgia is a chronic pain disorder involving the trigeminal nerve that causes sudden, intense, electric shock-like facial pain. It usually affects one side of the face.⁴

The patient’s mother also had a history of trigeminal neuralgia, a finding the authors considered potentially relevant. However, the physicians found no evidence that active Lyme disease explained her current illness.

“However, anaplasmosis and ehrlichiosis can both develop over a shorter timeframe and without a noticeable rash, making these infections a more likely explanation of the patient’s signs and symptoms,” wrote the authors.¹

Laboratory testing revealed leukopenia, thrombocytopenia, mild hyponatremia, elevated liver enzymes, and an elevated C-reactive protein level. CT imaging of the head and neck was unremarkable.

Lumbar puncture showed no evidence of bacterial or viral infection, including Lyme disease. MRI was recommended but could not be performed because the patient had a steel stapes implant from an earlier ear procedure.

PCR testing identified anaplasmosis

Because of the patient’s frequent tick exposure, systemic symptoms, and abnormal laboratory findings, the infectious disease team considered anaplasmosis and ehrlichiosis. These infections can develop relatively quickly following tick exposure and often occur without a noticeable rash.

“To confirm the suspected diagnosis, a tick-borne disease panel was ordered and was positive for Anaplasma phagocytophilum DNA by PCR,” the authors reported.¹

The PCR panel was negative for Borrelia burgdorferi, Babesia microti, Borrelia miyamotoi, and Ehrlichia chaffeensis.

Because the patient had recently completed treatment for presumed Lyme disease and PCR testing confirmed Anaplasma phagocytophilum, the authors considered acute anaplasmosis the most likely explanation for her systemic illness and a possible explanation for her new-onset trigeminal neuralgia.

Can anaplasmosis affect the nervous system?

Neurologic complications of anaplasmosis are considered uncommon. Most patients develop nonspecific symptoms such as fever, chills, fatigue, muscle aches, and headache. Laboratory abnormalities frequently include leukopenia, thrombocytopenia, and elevated liver enzymes.¹

Rare neurologic manifestations have included meningoencephalitis, cranial nerve palsies, demyelinating polyneuropathy, brachial plexopathy, and, in a small number of published case reports, trigeminal neuralgia.^1,3

Two published case reports have described patients with PCR-confirmed Anaplasma phagocytophilum infection whose clinical presentation included trigeminal neuralgia, suggesting this remains an uncommon neurologic manifestation rather than a typical feature of anaplasmosis.^1,3

The woman was treated with doxycycline 100 mg twice daily for 2 weeks together with gabapentin 300 mg twice daily for trigeminal neuralgia.¹

She reported marked improvement in her headache. Follow-up laboratory testing showed resolution of her leukopenia and thrombocytopenia together with improvement in her liver enzyme abnormalities.

The authors emphasized that clinicians should consider Lyme disease, anaplasmosis, and ehrlichiosis in patients from tick-endemic areas who present with fever, headache, myalgia, or other nonspecific symptoms, even when a rash is absent.

Trigeminal neuralgia has also been reported with Lyme disease

A 1996 report in the Journal of Neurology described trigeminal neuralgia as a clinical manifestation of Lyme neuroborreliosis.² Together with more recent anaplasmosis case reports, these observations suggest that trigeminal neuralgia can occur with certain tick-borne infections, although it remains uncommon.

Lyme neuroborreliosis more commonly presents with meningitis, radicular pain, or cranial neuropathies such as facial nerve palsy. Therefore, trigeminal neuralgia in a patient with possible tick exposure should not automatically be attributed to Lyme disease.

Clinicians should also consider structural nerve compression, multiple sclerosis, dental or facial disorders, and other tick-borne coinfections. Clinical history, neurologic examination, imaging when appropriate, laboratory findings, and the timing of symptoms all help guide the diagnosis.

Frequently Asked Questions

Can Lyme disease cause trigeminal neuralgia?

Published case reports have described trigeminal neuralgia in patients with Lyme neuroborreliosis, but it remains an uncommon neurologic manifestation. Facial nerve palsy is a much more frequently recognized cranial nerve complication of Lyme disease.²

Can anaplasmosis cause trigeminal neuralgia?

Published case reports have described trigeminal neuralgia in patients with PCR-confirmed Anaplasma phagocytophilum infection. Although these reports suggest an association, trigeminal neuralgia remains an uncommon neurologic manifestation of anaplasmosis rather than a typical presentation.^1,3

What are the neurologic symptoms of anaplasmosis?

Headache is common in anaplasmosis. Less common neurologic manifestations include meningoencephalitis, cranial nerve palsies, demyelinating polyneuropathy, brachial plexopathy, and, in rare published cases, trigeminal neuralgia.^1,3

Does anaplasmosis usually cause a rash?

No. A rash is uncommon in anaplasmosis. Patients more often develop fever, chills, headache, fatigue, muscle aches, leukopenia, thrombocytopenia, and elevated liver enzymes.¹

Clinical Takeaway

Published case reports have described trigeminal neuralgia in both Lyme neuroborreliosis and anaplasmosis, although it remains an uncommon neurologic manifestation of either infection.

In this patient, PCR-confirmed Anaplasma phagocytophilum infection, characteristic laboratory abnormalities, and rapid improvement following doxycycline supported the authors’ conclusion that acute anaplasmosis was the most likely explanation for her systemic illness and a possible explanation for her trigeminal neuralgia.

Clinicians should consider Lyme disease, anaplasmosis, ehrlichiosis, and other causes of trigeminal neuralgia when patients present with severe facial pain together with recent tick exposure or compatible systemic findings.

Related Articles

Learn more about neurologic manifestations of anaplasmosis and other tick-borne infections:

Anaplasmosis in the brain
A woman with anaplasmosis and Babesia infection
Lyme disease, Babesia, and anaplasmosis following a tick bite

References

1. LeDonne MJ, Ahmed SA, Keeney SM, Nadworny H. Trigeminal Neuralgia as the Principal Manifestation of Anaplasmosis: A Case Report. Cureus. 2022;14(1):e21668.
2. Fritz C, Rösler A, Heyden B, Braune HJ. Trigeminal neuralgia as a clinical manifestation of Lyme neuroborreliosis. J Neurol. 1996;243(4):367-368.
3. Merrill R, Pratt I, Simon EL. Trigeminal Neuralgia Unmasked: A Case of Anaplasma phagocytophilum Infection. J Emerg Med. 2025;72:83-86.
4. MedlinePlus. Trigeminal neuralgia. U.S. National Library of Medicine.

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Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention