What is trigeminal neuralgia?
Trigeminal neuralgia is a facial pain condition affecting the trigeminal nerve, which carries sensation from the face to the brain. It causes abrupt, intense stabbing or electric shock-like pains, usually on one side of the face, lasting seconds to a couple of minutes but often striking in clusters. Attacks can be triggered by light touch, chewing, talking, brushing teeth or even a breeze — making ordinary life exhausting.
It most often starts after the age of 50 and is more common in women. In many cases a blood vessel pressing on the nerve is responsible; occasionally it is linked to MS or other causes. Diagnosis is based on the characteristic history, with an MRI scan usually arranged to look for nerve compression and exclude other conditions.
Common symptoms
- Sudden, severe electric shock-like facial pain
- Pain on one side of the face, often cheek or jaw
- Attacks lasting seconds to two minutes, often in clusters
- Pain triggered by touch, chewing, talking or cold air
- Fear of eating or washing the face due to triggers
- Pain-free intervals between attacks or episodes
How long will you wait?
Routine NHS neurology referrals commonly take four to eight months, with further waits for MRI and for neurosurgical opinion if a procedure is being considered.
Privately, you can typically see a consultant neurologist or facial pain specialist within 3–7 days, with MRI within 1–2 weeks.
NHS England median referral-to-treatment wait: 12.4 weeks, with 2.5 million people waiting over 18 weeks (May 2026). Individual waits vary by trust and urgency.
Treatment options
- Carbamazepine. The first-line medication, effective for most people, with oxcarbazepine as a common alternative.
- Other neuropathic agents. Lamotrigine, gabapentin or baclofen when first-line treatment is not tolerated or insufficient.
- Microvascular decompression. An operation to move the blood vessel compressing the nerve, offering the best chance of long-term relief.
- Targeted procedures. Less invasive options such as radiofrequency ablation, glycerol injection or stereotactic radiosurgery for those unsuitable for surgery.
What does private treatment cost?
As a guide, a private consultation costs around £250–£350 and an MRI scan around £400–£800; surgical treatments such as microvascular decompression are quoted individually and can run to £15,000–£25,000 self-pay.
Does health insurance cover trigeminal neuralgia?
Private medical insurance usually covers diagnosis — consultations and MRI — and generally covers surgical treatment such as microvascular decompression when clinically indicated, subject to pre-authorisation. Long-term medication management may be viewed as chronic condition care and fall outside cover. As ever, pre-existing symptoms disclosed before the policy started may be excluded.
Frequently asked questions
Is trigeminal neuralgia the same as toothache or TMJ pain?
No, though it is frequently mistaken for dental problems, and many people have dental work before the true diagnosis emerges. Trigeminal neuralgia pain is electric shock-like, momentary and touch-triggered, whereas dental and jaw-joint pain is usually duller and more sustained. If severe shooting facial pain persists after dental causes are excluded, ask about referral to a neurologist or facial pain clinic.
Do ordinary painkillers help?
Standard painkillers such as paracetamol, ibuprofen and even opioids are largely ineffective for trigeminal neuralgia, because the pain arises from abnormal nerve firing rather than tissue damage. Carbamazepine, an anti-seizure medicine, is the established first-line treatment and helps the majority of people, which is itself so characteristic that a good response supports the diagnosis.
When is surgery considered?
Surgery is considered when medication stops working, causes intolerable side effects, or when a younger patient prefers a potentially longer-lasting solution. If MRI shows a blood vessel compressing the nerve, microvascular decompression offers the best long-term results, with most patients pain-free for many years. Less invasive procedures are effective alternatives for people who are older or have other health conditions.