The most common cause of facial pain is trigeminal neuralgia. Pain arises from the trigeminal nerve (fifth cranial nerve) and manifests as sharp, shooting pain lasting for a few seconds to minutes. Talking, brushing teeth, eating or putting on make-up triggers the pain.

An MRI scan must be carried out to exclude compression of the trigeminal nerve in the brain. A blood vessel, or rarely, tumour, can press onto the nerve and cause trigeminal neuralgia. If this happens, referral to a neurosurgeon is needed. In primary trigeminal neuralgia – where there is no cause for the pain – medications such as carbamazepine, gabapentin or pregabalin may help. Severe trigeminal neuralgia not responding to painkillers can be treated using radiofrequency ablation.

A special RF needle is inserted into the trigeminal ganglion. RF energy is then generated through a machine to create heat. This heat is transmitted through the needle tip to destroy the painful division of the trigeminal nerve. This is a day surgery procedure that is performed using CT guidance under mild sedation. RF ablation can effectively reduce facial pain in more than 90% of patients.