What are oro-facial pain conditions?

Orofacial pain conditions include:

  • Classical Trigeminal neuralgia
  • Trigeminal neuralgia with continuous background pain
  • Trigeminal autonomic cephalalgias (TACs)
  • Temporomandibular disorders (TMD)
  • Trigeminal neuropathy
  • Persistent idiopathic facial pain (previously known as atypical facial pain)
  • Post-herpetic neuralgia affecting the face
  • Post-traumatic facial pain

How can nerve blocks help manage facial pain?

Nerve blocks may help relieve certain orofacial pain conditions by reducing overactivity of the jaw and facial muscles, decreasing muscle tension, and modulating pain signalling. In appropriately selected patients, it may reduce the frequency, severity and duration of pain episodes. Individual responses vary, and not everyone will benefit.

Nerve blocks may be considered when:

  • Neuropathic facial pain conditions, such as trigeminal neuralgia, trigeminal neuropathy or persistent idiopathic facial pain, have not responded adequately to conventional treatments.
  • Nerve sensitivity is contributing to facial pain or headaches.
  • Medications are causing too many side effects
  • Dull pain to the mid face or the mandible has not responded to medications
  • Temporomandibular disorders (TMD) have not responded adequately to splints, physiotherapy or medications.

Expected Benefits

    Patients who respond to treatment may experience:

  • Fewer episodes of pain
  • Reduced pain intensity
  • Less reliance on pain medications
  • Improved sleep, energy, and concentration
  • Better ability to work, socialise, and carry out everyday activities
  • Improved quality of life

Response to treatment varies considerably between individuals. Some patients notice improvement within hours or days, while others may require more than one treatment. The duration of benefit can range from days to several months, and unfortunately some patients do not experience meaningful pain relief.

Are nerve blocks safe?

Yes. Facial nerve blocks are generally considered safe when performed by an experienced clinician using appropriate techniques and, where indicated, ultrasound guidance. Serious complications are uncommon.

For selected patients, nerve blocks may reduce the need for long-term use of medications such as carbamazepine, oxcarbazepine, gabapentin, or pregabalin. Unlike these medications, nerve blocks have little or no ongoing systemic exposure, avoiding many of the cumulative side effects associated with long-term drug therapy, such as drowsiness, dizziness, cognitive impairment, poor balance, weight gain, and medication interactions. 

However, nerve blocks carry their own procedural risks, and the choice of treatment should be individualised after discussion with your consultant. 

Side Effects

Very Common side effects

(may affect more than 1in 10 patients):
  • Temporary numbness in the treated area
  • Mild discomfort or bruising at the injection site

Common side effects

(may affect up to 1in 100 patients):
  • Temporary increase in pain for 24–72 hours
  • Temporary weakness of nearby muscles (depending on the nerve treated)
  • Minor bleeding or swelling
  • Light-headedness or feeling faint

 Rare side effects

(may affect up to 1 in 1,000 patients):

  • Infection at the injection site
  • Allergic reaction to the local anaesthetic or other medications
  • Prolonged numbness lasting longer than expected
  • Temporary altered sensation (pins and needles)
  • Infection at the injection site
  • Allergic reaction to the local anaesthetic or other medications
  • Prolonged numbness lasting longer than expected
  • Temporary altered sensation (pins and needles)

Most side effects are mild and temporary.
⚠️ If you experience muscle weakness, avoid driving or using heavy machinery.

Treatment Plan at PainClinicNI

  • Consultation – confirm diagnosis and suitability
  • Initial nerve blocks or trial of Botox® injections – carefully targeted into the jaw, temples, mid-face and occipital nerves & muscles
  • Review of treatment at 3–6 months to plan further treatment if needed

Our Clinical Insight

We believe nerve blocks are a good option when:
  • Your pain pattern suggests that one or more specific nerves are contributing to your symptoms.
  • The diagnosis is uncertain and a diagnostic nerve block may help identify the source of your pain.
  • Medications are ineffective, poorly tolerated, or cause troublesome side effects.
  • You are experiencing a flare-up of neuropathic facial pain and temporary pain relief may help break the pain cycle.
  • Pain is preventing normal activities, sleep, work, or rehabilitation.
  • A minimally invasive treatment is preferred before considering more invasive procedures.