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Trigeminal Neuralgia

Checked: 02-01-2019 by Rob Adams Next Review: 02-01-2019

Overview

There are useful guidelines on diagnosis and management of Trigeminal Neuralgia in CKS.

In all cases a dental cause should be excluded by a general dental practitioner.

Please see Red Flag section below and consider Urgent Suspected Cancer (previously 2WW) or urgent referral if indicated.

If secondary care input is required then the Referral Service advises referral to the Maxfax team initially who run a facial pain service . The neurologists and neurosurgeons will also see patients with facial pain, but outpatient waits tend to be much longer.

Referral

Referral can be made by eRS to one of the following local services:

Oral Medicine (Max Fax) - Dental hospital. Referrals can be made by GDP or GP.
Neurology (general) - UHB or NBT. Waits can be very long for these services.
Neurosurgery (cradiofacial pain, trigeminal neuralgia) - NBT - RAS. Only if medical therapy has failed and surgical management is being considered. There may be long waits for treatment.

Red Flags

See the Brain and CNS Urgent Suspected Cancer section on Remedy.

Be aware of serious conditions which can lead to compression of the trigeminal nerve, or cause symptoms similar to those of trigeminal neuralgia, including:

Tumours, such as posterior fossa tumours, extracranial masses along the trigeminal nerve, perineural spread of existing malignancy, cavernous sinus masses.
Multiple sclerosis.
Epidermoid, dermoid, or arachnoid cysts.
Aneurysm, or arteriovenous malformation.

Assess for the presence of red flag symptoms and signs that may suggest a serious underlying cause, including:

Sensory changes.
Deafness or other ear problems.
History of skin or oral lesions that could spread perineurally.
Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally.
Optic neuritis.
Family history of multiple sclerosis.
Age of onset before 40 years.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.