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

If any of the following, admit or refer urgently for specialist assessment:
 
Red flag Rationale
Sensory changes Suggest nerve compression or demylination (e.g. multiple sclerosis or tumour)
Deafness or other ear problems Possible acoustic neuroma (compress 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)

1st line: carbamazepine
  • Start at 100mg up to twice daily, and titrate upwards until pain relieved
  • Maximum dose: 1600 mg daily

If carbamazepine not appropriate of not effective: seek advice from secondary care (do not offer any other drug treatment unless advised)
Author: Adams Lau
Reviewer:
Last edited: 19/07/25