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REMEDY : BNSSG referral pathways

Trigeminal Neuralgia

Checked: 02-01-2019 by Rob.Adams Next Review: 02-01-2020

Overview

There are useful guidelines on diagnosis and management of Trigeminal Neuralgia in CKS.

In all cases a dental cause should be excluded by a general dental practitioner.

Please see Red Flag section below and consider 2WW or urgent referral if indicated.

If secondary care input is required then the Referral Service advises referral to the Maxfax team initially  who run a facial pain service . The neurologists and neurosurgeons will also see patients with facial pain, but outpatient waits tend to be much longer.

Referral

Referral can be made by eRS to one of the following local services:

  • Oral Medicine (Max Fax) - Dental hospital. Referrals can be made by GDP or GP.
  • Neurology (general) - UHB or NBT. Waits can be very long for these services.
  • Neurosurgery (cradiofacial pain, trigeminal neuralgia) - NBT - RAS. Only if medical therapy has failed and surgical management is being considered. There may be long waits for treatment.

 

Red Flags

See the Brain and CNS 2WW section on Remedy.

Be aware of serious conditions which can lead to compression of the trigeminal nerve, or cause symptoms similar to those of trigeminal neuralgia, including:

  • Tumours, such as posterior fossa tumours, extracranial masses along the trigeminal nerve, perineural spread of existing malignancy, cavernous sinus masses.
  • Multiple sclerosis.
  • Epidermoid, dermoid, or arachnoid cysts.
  • Aneurysm, or arteriovenous malformation.

Assess for the presence of red flag symptoms and signs that may suggest a serious underlying cause, including:

  • Sensory changes.
  • Deafness or other ear problems. 
  • History of skin or oral lesions that could spread perineurally.
  • Pain only in the ophthalmic division of the trigeminal nerve (eye socket, forehead, and nose), or bilaterally.
  • Optic neuritis.
  • Family history of multiple sclerosis.
  • Age of onset before 40 years.