Trigeminal neuralgia
Brief description of the condition
Episodic, sudden onset, excruciating facial pain in the distribution of the trigeminal nerve (usually cheek or lower jaw), typically lasting a few seconds to a few minutes, and resolving entirely or almost entirely. Not caused by trauma. Classically there is an area of the face or mouth that when lightly touched elicits the pain, although can be reported as arising spontaneously. May present as atypical dental pain and the patient may be convinced of a dental cause.
Key signs and symptoms
- Pain (excruciating stabbing or burning; short-lived; usually unilateral i.e. only one side of the face)
- Recurring episodes often escalating in frequency
- Weight loss due to fear of eating
Initial management
Urgently refer to a specialist service for a definitive diagnosis, investigations and further management.57
- Red flag symptoms that might require a more urgent referral include: sensory or motor deficits, deafness or other ear problems, optic neuritis, history of malignancy, bilateral trigeminal neuralgia pain, systemic symptoms (e.g. fever, weight loss) and presentation in patients aged under 30 years.
- General medical practitioners may initiate medical management while referring for specialist assessment.57
Consider use of topical lidocaine (sprayed into the nostril on the affected side) or a long-acting local anaesthetic by infiltration or block in the affected area as a temporary measure.57
Subsequent care (medical)
Provide follow-up medical care in liaison with a specialist for diagnosis, treatment options and ongoing management of the condition.