Can trigeminal neuralgia happen on both sides of the face?or switch from right to left? getiing progressively worse. low grade fever. lost 90lbs in6mo

Bilateral TGN: Is rare, seen in 1-6% of cases & closer to 1% in my experience. Same things that cause tgn on 1 side can cause it on both. Systemic disorders & neurological diseases such as paget's, ms & other demyelinating diseases are more often seen when on both sides. Unintentional weight loss w/ fever raise possibility for infiltrating process, malignancy, paraneoplastic & less likely ctd or infectious.

Unlikely: The pain of idiopathic Trigeminal Neuralgia occurs unilaterally in the distribution of one or more divisions of the trigeminal nerve. TN rarely occurs bilaterally; when it does, it is usually secondary to multiple sclerosis. TN never crosses the midline but on rare occasions, may switch to the opposite side in different attack periods. See orofacial pain specialist for proper diagnosis.