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At the Headache and Facial Pain Service we know how difficult it can be to get an accurate diagnosis for chronic headache and facial pain, given there are many possible causes and ways pain can present itself. At The Harley Street Clinic, our dedicated team of expert consultant neurologists and neurosurgeons work with state-of-the-art diagnostics to offer some of the best support and interventions that London and the UK has to offer.
The service prides itself on its multidisciplinary approach for every patient, where we will determine the most appropriate treatment pathway, whether operative or non-operative, on a case-by-case basis. This means each patient is discussed at length with other relevant sub-specialist consultants to establish a greater likelihood of a secure diagnosis, which avoids unnecessary interventions and reduces the chance of procedural complications.
Patients are also reviewed by our Neuro Oncology MDT if there is evidence of a tumour, as well as being reviewed by Consultant Neurologist Dr Giorgio Lambru, one of the UK’s leading experts in headaches.
Capabilities
Specialists in complex facial pain
Our specialists are responsible for establishing one of the first complex facial pain clinics in the UK at St Thomas’s Hospital, with expertise that has been refined and honed over 12 years being brought to The Harley Street Clinic.
Our consultants Mr Sinan Barazi and Mr Giorgio Lambru were appointed joint chairs of the Medical Advisory Board of the Trigeminal Neuralgia Association of the United Kingdom in 2023, whilst Mr Nicholas Thomas is former President of the British Skull Base Society. Our neurosurgeons regularly perform procedures together for facial pain.
At the heart of every diagnosis is a detailed patient history for both for headaches and facial pain. This helps to determine the best diagnostic route, most commonly an MRI scan.
Our consultants are supported by a number of specialists, including neuroradiologists and maxillofacial surgeons, to create a robust multidisciplinary team to ensure the best patient outcomes.
What you can expect
We will arrange a prompt appointment around your schedule. During the appointment your consultant will discuss your symptoms and medical history before referring you for investigations tailored to your needs.
We can generally offer same-day blood tests, with CT and MRI imaging being performed within a couple of days. A follow up appointment will be arranged soon after to discuss your results and develop a treatment plan.
Operative: If surgery is recommended, we offer state-of-the-art intraoperative neuromonitoring of cranial nerves and spinal cord function, to mitigate the risk of nerve damage. Due to the complexity of the procedure, our neurosurgeons share the responsibility of the surgery and work closely with ear, nose and throat skull-based surgeons and maxillofacial surgeons to combine expertise and make the operative outcome the best it can be.
Non-operative: If non-operative management is considered the appropriate treatment, this could involve a range of treatments including Botox, drug therapy, intravenous injections, infusions, biologics or neuromodulation (therapy based on modulating targets by using electricity or magnetic fields).
After surgery, The Harley Street Clinic provides specialist facilities overseen by medical and nursing staff experienced in managing neurosurgical patients. If you’ve had cranial surgery, you should expect an overnight stay in the ITU, monitored by one-to-one nursing teams, before being moved to the surgical ward where you will stay for 2 days.
Post-discharge, you will have access to on-call radiologists and consultants, with instant and remote access to imaging if required. There will be a follow-up appointment with your neurosurgeon 6 weeks after the procedure, or as and when required.
Facial pain diagnosis - Mr Nick Thomas and Mr Sinan Barazi
Conditions we treat
- Cervicogenic headaches
- Cluster headache
- Facial pain
- Glossopharyngeal neuralgia
- Hemicrania continua
- High and low pressure headache
- Medically intractable headache
- Medication overuse headaches
- Migraines
- Nervus intermedius neuralgia
- New daily persistent headache
- Occipital neuralgia
- Paroxysmal hemicrania
- Post traumatic headache
- Primary stabbing headache
- Ramsay Hunt syndrome
- Short-lasting unilateral neuralgiform with cranial autonomic symptoms (SUNA)
- Short-lasting unilateral neuralgiform with conjunctival injection and tearing (SUNCT)
- Short-lasting unilateral neuralgiform headache attacks (SUNHA)
- Sinus headache
- Temporo-mandibular joint pain
- Tension headaches
- Trigeminal neuralgia
- Trigeminal neuropathy
- Trigeminal autonomic cephalgias (TACs)
- Temporal arteritis
Headaches and facial pain related to:
- Meningiomas
- Pituitary tumours
- Vestibular schwannomas
- Other skull base tumours
Treatments available
- Anti-CGRP monoclonal antibodies
- Botulinum Toxin Injection (Botox)
- Drug therapy
- Microvascular decompression of cranial nerve
- Intravenous lidocaine
- Intravenous phenytoin
- Occipital nerve block
- Occipital nerve stimulation
- Medication overuse withdrawal
- Percutaneous technique via glycerol injection or Stereotactic radiosurgery e.g. gamma knife
- Spinal cord stimulation
- Sphenopalatine ganglion blocks
- Surgical excision of tumours
- Surgery for chronic headaches
- Transcranial magnetic stimulation
- Trigeminal nerve stimulation
- Trigeminal nerve blocks (tic injection)
- Vagus nerve stimulation
Facial Pain treatment plan – Mr Nick Thomas and Mr Sinan Barazi
Providing a second opinion
There are many reasons why you could be considering a second opinion, including you are not confident that the correct diagnosis has been made, you still have unanswered questions, or your condition has returned following treatment. It's best to get a second opinion soon after a condition or problem is diagnosed but, even if you've already started treatment, it's not too late to get another opinion from our experts.