Trigeminal neuralgia causes brief attacks of severe facial pain, often described as an electric shock. It usually affects one side and may be triggered by touching the face, chewing or brushing teeth. Persistent facial pain can have other causes, so the diagnosis should be established before choosing a treatment. [1] [2]
How is facial pain assessed?
Describe where the pain occurs, how long each attack lasts, what triggers it and whether there is numbness or pain between attacks. Examination and, where appropriate, dental assessment help distinguish trigeminal neuralgia from dental disease, headache disorders and other facial pain conditions. [2]
MRI is part of the specialist work-up recommended by the European Academy of Neurology. It can investigate causes such as multiple sclerosis or a tumour and help assess the relationship between a blood vessel and the nerve. Vascular contact on a scan alone does not establish the diagnosis. [3]
Which treatments are usually considered first?
Carbamazepine or oxcarbazepine are first-choice medicines in the European guideline. The prescription should account for your other medicines, health conditions and potential adverse effects. If pain remains disabling or treatment is poorly tolerated, specialist review can consider alternatives or a neurosurgical opinion. [3]
Singapore’s Health Sciences Authority advises HLA-B*1502 testing before starting carbamazepine in new patients of Asian ancestry. The result should be available before prescribing. This helps identify increased risk of serious skin reactions, but a negative result does not remove every risk. [4]
Do not start, increase or stop these medicines on your own. A severe rash with blisters or ulcers needs emergency medical assessment. Tell the prescriber promptly about other troublesome side effects. [5]
When might a procedure or surgery be discussed?
If medicines do not provide acceptable control, the options may include percutaneous nerve procedures, stereotactic radiosurgery or microvascular decompression in suitable patients. These treatments have different aims, recovery requirements and risks; a peripheral nerve block is not the same procedure as treatment of the trigeminal ganglion. [3] [5]
Some procedures deliberately alter nerve function and can cause facial numbness, sometimes permanent. Other risks depend on the technique and include eye problems or persistent painful numbness. Relief can be incomplete or temporary. Ask which procedure is proposed and how it compares with the alternatives for your type of trigeminal neuralgia. [5]
Which symptoms need urgent help?
Sudden facial drooping, arm weakness or speech difficulty needs emergency assessment, even if it settles. These symptoms should not be assumed to be trigeminal neuralgia. Do not wait for a routine website enquiry response. [6]
Questions to bring to the consultation
Ask what supports the diagnosis, whether further dental or neurological assessment is needed, and which findings would change the plan. Discuss pain control alongside eating, sleep and daily activity, and agree when medicines or a procedure should be reviewed.
Related information
Evidence and further reading
- Trigeminal neuralgia: overview. NHS; Reviewed 27 January 2023.
- Trigeminal neuralgia: diagnosis. NHS; Reviewed 27 January 2023.
- European Academy of Neurology guideline on trigeminal neuralgia. European Journal of Neurology; 2019.
- Reminder to verify HLA-B*1502 status in new patients of Asian ancestry before starting carbamazepine treatment. Singapore Health Sciences Authority; 10 December 2020.
- Trigeminal neuralgia: treatment. NHS; Reviewed 27 January 2023.
- Symptoms of a stroke. NHS; Reviewed 12 September 2024.
Evidence sources checked: 10 November 2026.
This information supports discussion with a healthcare professional and does not replace an individual assessment.