The first-choice treatment for trigeminal neuralgia — highly effective, with interactions that need taking seriously.
Explained by a GMC-registered GP, not a leaflet
Honest about what we can and cannot prescribe remotely
Side effects given the same weight as benefits
Your NHS records in the room, with your consent
Care led personally by Dr Khan
Attentive, unhurried care that listens properly
Five-star Google reviews from the people we have looked after
Registered with the Care Quality Commission
Carbamazepine stabilises overactive nerve membranes by blocking sodium channels, damping down the abnormal electrical firing that causes both seizures and neuropathic pain.
In trigeminal neuralgia it is first-line and it is genuinely effective — most people get substantial relief, and a good response is considered supportive of the diagnosis.
It is not an ordinary painkiller. Paracetamol, ibuprofen and opioids are largely useless in trigeminal neuralgia, which is why people often arrive having tried everything in the cupboard without success.
Dizziness, unsteadiness and drowsiness are far worse if the dose is increased quickly, and they are the commonest reason people abandon a medicine that would have worked. Going up in small steps every few days is the difference between tolerating it and not.
Trigeminal neuralgia naturally remits and relapses. After a period of good control the dose is usually reduced slowly to find the minimum needed, and some people come off it entirely between episodes.
Most of these ease as you adjust, which is exactly why slow titration matters.
People of Han Chinese, Thai and some other Asian backgrounds should be tested for HLA-B*1502 before starting, because it markedly raises the risk of severe skin reactions.
Pregnancy is a significant issue. Carbamazepine carries a risk of birth defects, and it also reduces the effectiveness of hormonal contraception. Anyone of childbearing potential needs a proper discussion about reliable contraception and pre-pregnancy planning before starting.
Caution in liver or kidney impairment, glaucoma, and in older people.
Carbamazepine is a strong enzyme inducer — it speeds up the breakdown of a long list of other medicines and makes them less effective. This is one of the most interaction-prone medicines in general use.
We can be genuinely useful at the diagnosis and the start of treatment, and we are honest that ongoing management usually belongs with your own GP or a neurologist.
Trigeminal neuralgia is frequently misdiagnosed for years as dental pain — people commonly have root canal treatment or extractions before anyone recognises it. The history is distinctive: brief, severe, electric-shock facial pain triggered by light touch, chewing, cold air or brushing teeth.
What a consultation covers: recognising the pattern, explaining why ordinary painkillers do not work, arranging the baseline bloods, and getting the titration right.
What needs in-person or specialist assessment:
Given the monitoring and interaction burden, we would not take this on as a long-term remote-only prescription. A prescription is never guaranteed. This page is information, not an offer to supply.
Carbamazepine is an inexpensive generic. On a private prescription the cost is broadly comparable to the England NHS prescription charge. NHS prescriptions are free in Wales.
Stay on the same manufacturer's product where possible — for antiepileptics, switching brands can change blood levels enough to matter.
Do not stop carbamazepine suddenly, particularly if you take it for epilepsy — abrupt withdrawal can provoke seizures.
For trigeminal neuralgia, the dose is reduced gradually once you have had a good period of control, because the condition remits naturally and many people need less than they think.
Any rash, mouth ulcers, fever, sore throat, bruising or unexplained bleeding. These are the reactions that matter, and they need same-day attention rather than waiting.
Because this is nerve pain, not tissue pain. Paracetamol, ibuprofen and even opioids do very little for trigeminal neuralgia, which is why people often arrive having tried everything.
Trigeminal neuralgia is very commonly mistaken for dental pain, and people frequently have root canals or extractions before it is recognised. Brief electric-shock pain triggered by light touch, cold air or chewing is the giveaway.
Often not indefinitely. The condition remits and relapses, so the dose is usually reduced after a good period of control, and some people stop entirely between episodes.
Yes — this is important and frequently missed. Carbamazepine substantially reduces the effectiveness of hormonal contraception. You need a method that is not affected, and this must be sorted before starting.
Any rash — stop and seek help the same day, particularly with fever, mouth ulcers or blistering. Serious skin reactions are rare but genuinely dangerous.
To check the blood count, liver and sodium. Low sodium is common, often silent, and a frequent cause of confusion and falls in older people taking it.
Yes, and it is under-offered. Microvascular decompression has good long-term results. If you are struggling on high doses, ask about a neurosurgical opinion.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
September 8, 2026
On this page
Ongoing
Time to be seen
Appointment length
Your NHS record in the room
Written treatment plan
Told when a test isn’t needed
Cost
Same day, usually
20 minutes
Yes, with your consent
Included
Yes, and told why
£40 for 20 minutes
Varies by practice
Typically 10 minutes
Yes, your full record
Not routinely
Usually
Free
Same day
Often 10 to 15 minutes
Usually not
Sometimes charged
Varies by provider
Often a subscription
Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
Yes, with your consent. We can access your Summary Care Record during the consultation, so your current medications, allergies and significant history are in the room. That means fewer questions you have already answered elsewhere, and safer prescribing.
No. We are not here to replace GPs, only to support them. Your NHS practice remains responsible for your ongoing care, and with your consent we write to them after the consultation. We are useful when you need to be seen sooner, or want more time than a standard appointment allows.
Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
£40 for 20 minutes, self-pay. Membership is optional and never required. Priced for fairness, because we are not here to charge extortionate amounts for access to a doctor.
It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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