Trigeminal Neuralgia
NICE CKS Trigeminal neuralgia. Last revised: Jan 2024.
NICE Clinical guideline [CG173] Neuropathic pain in adults: pharmacological management in non-specialist settings. Last updated: Sep 2020.
Guidelines
Management
Referral Criteria
If any of the following, admit or refer urgently for specialist assessment:
| Red flag | Rationale |
|---|---|
| Sensory changes | Suggest nerve compression or demyelination (e.g. multiple sclerosis or tumour) |
| Deafness or other ear problems | Possible acoustic neuroma (compresses both CN V and VIII) |
| History of skin or oral lesions that could spread perineurally | |
| Pain only in the ophthalmic division of CN | Possible sinonasal / orbital / intracranial pathology |
| Bilateral symptoms | Suggest systemic causes (e.g. multiple sclerosis, sarcoidosis) |
| Optic neuritis | Suggest multiple sclerosis |
| Family history of multiple sclerosis | |
| Onset <40 y/o | Suggest secondary causes (e.g. multiple sclerosis, genetic syndromes) |
Pharmacological Management
1st line: carbamazepine
- Start at 100mg up to twice daily, and titrate upwards until pain is relieved
- Maximum dose: 1600 mg daily
If carbamazepine not appropriate or not effective: seek advice from secondary care (do not offer any other drug treatment unless advised)
References
Original Guideline