How to treat: Trigeminal neuralgia
Trigeminal neuralgia is often described as a “forked lightning” pain in the face. Andria Merrison and Geraint Fuller take a look at medical and surgical treatment options for this common condition
Patients describe the sudden and severe pain of trigeminal neuralgia as a “red hot needle” or a “forked lightening” pain in the face. The French term “tic doloreux” emphasises the suddenness of the pain that may be triggered by touch or cold. This characteristic pain affects four to five people in 100 000. It occurs in bouts lasting weeks or months, with months or years of remission. Evidence is increasing that in most patients trigeminal neuralgia is caused by compression of the trigeminal nerve root, close to its entry into the pons, by an aberrant arterial or venous loop.1 Other compressive lesions are responsible in a few patients. About 2% of patients with trigeminal neuralgia have multiple sclerosis.
Standard first line treatment is carbamazepine.23 Other drugs, including lamotrigine, phenytoin, gabapentin, oxcarbazepine, topiramate, baclofen, and clonazepam have some effect, although studies are more limited.3 Many patients fail to have a sustained