What are the common management strategies for patients with cranial nerve disorders in primary care?

Common management strategies for patients with cranial nerve disorders in primary care include:

• Recognition and referral: Promptly identify symptoms such as unilateral facial pain triggered by touching the face (suggestive of trigeminal neuralgia) and refer adults refractory to treatment for specialist assessment following neuropathic pain guidelines ¹.
• Referral for neuroimaging: Refer adults with facial pain associated with persistent facial numbness or abnormal neurological signs urgently using a suspected cancer pathway referral ¹.
• Blood tests and local pathway follow-up: For symptoms suggestive of temporal arteritis (e.g., scalp tenderness, jaw claudication), consider blood tests and follow local pathways for suspected giant cell arteritis, noting that a normal ESR does not exclude the diagnosis ¹.
• Assessment of sudden-onset symptoms: Refer immediately adults with sudden-onset speech or language disturbance for vascular event assessment per stroke pathways ¹.
• Management of vestibular symptoms: For adults with transient rotational vertigo, offer the Hallpike manoeuvre and canalith repositioning manoeuvre if trained personnel are available; otherwise, refer according to local pathways ¹.
• Consideration of functional neurological disorders: Recognize that some cranial nerve symptoms (e.g., dizziness, word-finding difficulties) may be part of functional neurological or anxiety disorders and may not require referral if no new neurological signs are present ¹.
• Referral for suspected dystonia: Refer adults with suspected cervical dystonia or other dystonias for specialist assessment and possible botulinum toxin treatment ¹.
• Monitoring and supportive care: For loss of smell or taste lasting more than 3 months without other neurological signs, consider neuroimaging; routine referral is not required if imaging is normal ¹.