What is Trigeminal Neuralgia?

Trigeminal Neuralgia (TN) is a chronic neuropathic pain condition affecting the trigeminal nerve, which carries sensation from the face to the brain. It is characterised by sudden, severe, electric shock-like attacks of facial pain lasting from a few seconds up to two minutes, usually affecting one side of the face.

The pain can be triggered by everyday activities such as talking, brushing your teeth, eating, shaving, washing your face, or even a light breeze on the skin.

In classical trigeminal neuralgia, there is no pain between attacks, although some patients may develop more persistent pain over time. 

Trigeminal neuralgia can be intensely painful and disabling. However, with appropriate diagnosis and treatment, many patients achieve significant pain relief and improved quality of life.

Common Symptoms

  • Sharp, stabbing, or shock-like facial pain
  • Sudden attacks lasting seconds to minutes
  • Pain typically affecting one side of the face
  • Pain triggered by touch, chewing, speaking, or brushing teeth
  • Attacks may become more frequent and severe over time

When to Seek Help:

If you experience sudden, severe facial pain, it is important to seek prompt assessment by your dentist to exclude a dental cause. 

Assessment by a neurologist and, where appropriate, an oral and maxillofacial surgeon is also important to rule out underlying conditions such as multiple sclerosis (MS), tumours, or other structural causes.

We also help determine the precise pain phenotype, as management strategies differ depending on the underlying diagnosis. This includes distinguishing classical trigeminal neuralgia, secondary trigeminal neuralgia, trigeminal neuralgia with concomitant persistent pain , persistent idiopathic facial pain, and trigeminal autonomic cephalalgias, as each requires a different treatment approach.

Early diagnosis and appropriate treatment can significantly improve symptoms and quality of life.

At PainClinicNI, we can help if medications prescribed by your GP or neurologist have been ineffective or have caused intolerable side effects. We also offer trigeminal nerve blocks to help settle acute flare-ups and provide temporary pain relief while longer-term treatment strategies are optimised.

Management of Trigeminal Neuralgia

Managing trigeminal neuralgia begins with accurately determining the pain phenotype, as treatment varies depending on the underlying diagnosis. Management may include medications, interventional procedures, and, in selected cases, surgery. 

Each treatment plan is tailored to the individual's condition, symptoms, and response to previous therapies.

Medications

  • Anticonvulsants (e.g., carbamazepine, oxcarbazepine) are often the first line of treatment.
  • Antidepressants such as Amitriptyline or Duloxetine may be used.

Medications

  • Anticonvulsants (e.g., carbamazepine, oxcarbazepine) are often the first line of treatment.
  • Antidepressants such as amitriptyline or duloxetine may be used.

Surgical Options (for severe cases and assessed via neuro surgeons):

  • Microvascular decompression (MVD): A neurosurgical procedure that relieves pressure on the trigeminal nerve caused by a blood vessel. It is most effective when MRI demonstrates clear neurovascular compression with morphological changes to the trigeminal nerve (e.g. distortion, indentation, or atrophy), rather than simple neurovascular contact alone.
  • Trigeminal ganglion ablation: Although often effective, these procedures carry a significant risk of facial numbness and, in some patients, may lead to painful trigeminal neuropathy (anaesthesia dolorosa) or other persistent neuropathic pain. Based on clinical experience, we no longer offer this irreversible therapy.
  • Gamma Knife radiosurgery: A non-invasive treatment that uses highly focused radiation to target the trigeminal nerve. This treatment is available in Leeds or Bristol following assessment and referral through the Neurosurgical Service at the Royal Victoria Hospital (RVH), Belfast.

Injection Therapies and Nerve Blocks:

  • Trigeminal nerve blocks can offer temporary relief by numbing the nerve.
  • Botox may be effective in certain cases, when medications and surgery hasn’t helped.
  • Stellate ganglion block is reserved for those patients, where there is an element of sensitisation and no actual cause is identifiable on imaging.

Injection Therapies and Nerve Blocks:

  • Trigeminal nerve blocks may provide temporary pain relief by numbing the affected nerve and helping to settle an acute flare-up.
  • Botox® may be considered as a preventive treatment in carefully selected patients whose pain has remained refractory to medications and, where appropriate, surgery.
  • Stellate ganglion block may be considered in selected patients with features of central sensitisation or sympathetically maintained pain, particularly when no ongoing structural cause is identified on imaging and conventional treatments have been unsuccessful.
  • Lidocaine infusion may be considered in selected patients to help reduce pain sensitivity and settle severe flare-ups, particularly where features of central sensitisation are present.

Supportive Care

  • Lifestyle changes to avoid known triggers
  • Pain management counselling.
  • Emotional support for coping with chronic pain

How Can We Help?

At PainClinicNI, we offer a comprehensive, evidence-based approach to low back pain. Our services include:
“We aim to restore comfort and confidence, helping you live with less pain.”