Medscape is available in 5 Language Editions – Choose your Edition here.


Trigeminal Neuralgia Medication

  • Author: Manish K Singh, MD; Chief Editor: Robert A Egan, MD  more...
Updated: Oct 22, 2015

Medication Summary

Carbamazepine remains the criterion standard, but a number of other drugs have been used for a long time and with fair success in trigeminal neuralgia (TN). These agents should be considered successively in case of resistance. Rarely, combination therapy can be provided, but it should remain exceptional for tolerance reasons and because a synergistic effect rarely occurs.[43] Duration of treatment depends on clinical evolution but usually is long term, often lasting years. Topical analgesics have failed in patients with ophthalmologic manifestations of trigeminal neuralgia.[66]


Anticonvulsant Agents

Class Summary

Anticonvulsant drugs reduce the excitability of gasserian ganglion neurons, preventing anomalous discharges and related lancinating volleys of pain. Thus, these agents may help control paroxysmal pain by limiting the aberrant transmission of nerve impulses and reducing the firing of nerve potentials in the trigeminal nerve.

Carbamazepine (Tegretol)


Carbamazepine is the criterion standard in the medical management of trigeminal neuralgia. A 100-mg tablet may produce significant and complete relief within 2 hours, and, for this reason, a 100 mg twice a day (bid) prescription is suitable to start. If this initial dose fails, one may push the dose to 1200 mg daily (qd), as the patient will tolerate, for initial relief; maintenance doses generally are lower, 100-800 mg daily bid. If using the extended-release caplet, begin with 200 mg qd and increase as needed to a maximum dose of 1200 mg/d bid. Titrating slowly improves tolerance.

So immediate, predictable, and powerful is the relief that if the patient does not respond at least partially to carbamazepine, one should reconsider the diagnosis of idiopathic trigeminal neuralgia. Note, however, that 15% of patients do not benefit from carbamazepine, forcing trials of other medications.

Gabapentin (Neurontin)


Small, uncontrolled studies have indicated possible effectiveness of gabapentin in patients whose pain has become refractory to carbamazepine. This agent is often better tolerated than carbamazepine by elderly patients. No placebo-controlled studies have been published, but several open trials have reported an improvement on this drug.

As for other indications, an adequate dosage seems to vary greatly, and a trial should include raising the dose (eg, 3600 mg/d) as long as no efficacy is yet encountered, before stopping it.

Lamotrigine (Lamictal, Lamictal ODT, Lamictal XR)


Lamotrigine provided sustained relief in 2 small prospective studies. In an open-label design by Lunardi et al, all 5 patients with symptomatic trigeminal neuralgia associated with multiple sclerosis (MS) and 10 of 15 patients with idiopathic disease gained complete relief when followed for 3-8 months.[37] Doses varied widely from 100-400 mg/d.

In a double-blind, placebo-controlled, crossover study, Zakrzewska et al found 400 mg of lamotrigine relieved the pain in 7 of 13 patients with trigeminal neuralgia compared with only 1 of 14 on placebo.[38]

The adverse event to prevent is a rash, sometimes severe and life threatening, mostly if titration is too rapid.

Phenytoin (Dilantin, Phenytek)


Phenytoin has a similar mechanism of action to carbamazepine but is probably less effective. Phenytoin may provide relief as an add-on drug when carbamazepine monotherapy wanes, as commonly happens after 1 or several years. This drug has several common adverse effects, which are often troublesome in older patients, and drug levels do not always correlate with efficacy.

Topiramate (Topamax)


This therapy is experimental. In a pilot study of 3 patients enrolled in a National Institutes of Health (NIH)–sponsored trial, investigators could not confirm the benefits of topiramate.[65] However, it may be a reasonable second-line agent.

Zvartau-Hind et al reported success in an uncontrolled, open-label trial of 200-300 mg daily in 6 patients with multiple sclerosis (MS), prescribed as monotherapy (in 5 of the 6 individuals) over a 6-month interval.[66] All 6 patients reported complete relief and appeared to tolerate the drug well. Solaro et al found 150-300 mg total daily doses relieved all trigeminal neuralgia pains in a case series of 4 patients, 2 with multiple sclerosis, 1 with idiopathic trigeminal neuralgia, and 1 with previous arteriovascular malformation resection, when followed for 6 months. Carbamazepine and gabapentin had previously failed in all patients.

Oxcarbazepine (Trileptal)


Oxcarbazepine is a close cousin of carbamazepine and presumably works on similar mechanisms. This agent offers a better tolerance and is easier to manage. Studies are limited, as opposed to the large body of high-level evidence with carbamazepine.

Daily maintenance doses of oxcarbazepine 400-2400 mg/d were effective in several small uncontrolled studies.[67] Three small, multicenter, double-blind randomized trials found it as efficacious as carbamazepine in newly diagnosed or refractory trigeminal neuralgia and to be better tolerated.[68]

The recommended starting dose is 300 mg bid. Note that this drug has not yet been approved by the US Food and Drug Administration (FDA) for trigeminal neuralgia.

This drug has not yet been approved by the FDA for trigeminal neuralgia (TN).


Skeletal Muscle Relaxants

Class Summary

Several small, uncontrolled studies in the 1970s and 1980s, including those by Parekh et al and Fromm et al, demonstrated effectiveness of baclofen, particularly when added to an existing regimen of carbamazepine that is not providing adequate pain control. Once baclofen is added to an anticonvulsant, the dosage of the anticonvulsant often can be reduced.

Baclofen (Lioresal, Gablofen)


Baclofen is the only medication in this class with published data to support efficacy. This drug may induce hyperpolarization of afferent terminals and inhibit both monosynaptic and polysynaptic reflexes at the spinal level.

Baclofen is most often used after therapy with carbamazepine has been initiated, and its effects may be synergistic with those of carbamazepine.


Tricyclic Antidepressants

Class Summary

Tricyclic antidepressants are a complex group of drugs that have central and peripheral anticholinergic effects, as well as sedative effects. They have central effects on pain transmission and block the active reuptake of norepinephrine and serotonin.



A minority of patients might respond to amitriptyline. Anticholinergic adverse effects are the limitation.



Class Summary

Toxins are a relatively recent experimental approach to management of trigeminal neuralgia and have been mentioned to respond to patient inquiries. These agents are not recommended because of scant evidence of efficacy. The mechanism of action of these agents remains unclear, but they appear to potentially decrease painful afferents.[67]

Botulinum toxin (BOTOX)


Subcutaneous injections of botulinum toxin have been beneficial in a pilot study of patients with ophthalmologic manifestations of trigeminal neuralgia, but these results await confirmation.

Contributor Information and Disclosures

Manish K Singh, MD Assistant Professor, Department of Neurology, Teaching Faculty for Pain Management and Neurology Residency Program, Hahnemann University Hospital, Drexel College of Medicine; Medical Director, Neurology and Pain Management, Jersey Institute of Neuroscience

Manish K Singh, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American Headache Society, American Association of Physicians of Indian Origin, American Medical Association, American Society of Regional Anesthesia and Pain Medicine

Disclosure: Nothing to disclose.


Gordon H Campbell, MSN FNP-BC, Neuroscience Nurse Practitioner, Neurology Service, Portland Veterans Affairs Medical Center; Primary Faculty, Clinical Instructor, and Guest Lecturer, Family Nursing Department, Oregon Health Sciences University School of Nursing

Gordon H Campbell, MSN is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Helmi L Lutsep, MD Professor and Vice Chair, Department of Neurology, Oregon Health and Science University School of Medicine; Associate Director, OHSU Stroke Center

Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology, American Stroke Association

Disclosure: Medscape Neurology Editorial Advisory Board for: Stroke Adjudication Committee, CREST2.

Siddharth Gautam, MBBS Resident Physician, Jersey Neuroscience Institute

Disclosure: Nothing to disclose.

Chief Editor

Robert A Egan, MD Director of Neuro-Ophthalmology and Stroke Service, St Helena Hospital

Robert A Egan, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, North American Neuro-Ophthalmology Society, Oregon Medical Association

Disclosure: Received honoraria from Biogen Idec for speaking and teaching; Received honoraria from Teva for speaking and teaching.


Jane W Chan, MD Professor of Neurology/Neuro-ophthalmology, Department of Medicine, Division of Neurology, University of Nevada School of Medicine

Jane W Chan, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Ophthalmology, American Medical Association, North American Neuro-Ophthalmology Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

James R Couch, MD, PhD, FACP Professor of Neurology, University of Oklahoma Health Sciences Center

Disclosure: Nothing to disclose.

Theodore J Gaeta, DO, MPH, FACEP Clinical Associate Professor, Department of Emergency Medicine, Weill Cornell Medical College; Vice Chairman and Program Director of Emergency Medicine Residency Program, Department of Emergency Medicine, New York Methodist Hospital; Academic Chair, Adjunct Professor, Department of Emergency Medicine, St George's University School of Medicine

Theodore J Gaeta, DO, MPH, FACEP is a member of the following medical societies: Alliance for Clinical Education, American College of Emergency Physicians, Clerkship Directors in Emergency Medicine, Council of Emergency Medicine Residency Directors, New York Academy of Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

J Stephen Huff, MD Associate Professor of Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia School of Medicine

J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Andrew W Lawton, MD Medical Director of Neuro-Ophthalmology Service, Section of Ophthalmology, Baptist Eye Center, Baptist Health Medical Center

Andrew W Lawton, MD is a member of the following medical societies: American Academy of Ophthalmology, Arkansas Medical Society, and Southern Medical Association

Disclosure: Nothing to disclose.

Marc E Lenaerts, MD, FAHS Staff Neurologist, Mercy Medical Group; Associate Clinical Professor of Neurology, Department of Neurology, University of California, Davis, School of Medicine

Marc E Lenaerts, MD, FAHS is a member of the following medical societies: American Academy of Neurology, American Headache Society, and International Headache Society

Disclosure: Nothing to disclose.

Jorge E Mendizabal, MD Consulting Staff, Corpus Christi Neurology

Jorge E Mendizabal, MD is a member of the following medical societies: American Academy of Neurology, American Headache Society, National Stroke Association, and Stroke Council of the American Heart Association

Disclosure: Nothing to disclose.

Hampton Roy Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Tom Scaletta, MD Chair, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine

Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Brian R Younge, MD Professor of Ophthalmology, Mayo Clinic School of Medicine

Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.

  1. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004. 24 Suppl 1:9-160. [Medline].

  2. Burcheil KJ. Trigeminal neuralgia. In: Conn's Current Therapy. 1999:948-50.

  3. Osler W. The principles and practice of medicine. 8th ed. 1912:191-202.

  4. Burchiel KJ. Abnormal impulse generation in focally demyelinated trigeminal roots. J Neurosurg. 1980 Nov. 53(5):674-83. [Medline].

  5. Devor M, Amir R, Rappaport ZH. Pathophysiology of trigeminal neuralgia: the ignition hypothesis. Clin J Pain. 2002 Jan-Feb. 18(1):4-13. [Medline].

  6. Anderson VC, Berryhill PC, Sandquist MA, Ciaverella DP, Nesbit GM, Burchiel KJ. High-resolution three-dimensional magnetic resonance angiography and three-dimensional spoiled gradient-recalled imaging in the evaluation of neurovascular compression in patients with trigeminal neuralgia: a double-blind pilot study. Neurosurgery. 2006 Apr. 58(4):666-73; discussion 666-73. [Medline].

  7. Hess B, Oberndorfer S, Urbanits S, Lahrmann H, Horvath-Mechtler B, Grisold W. Trigeminal neuralgia in two patients with glioblastoma. Headache. 2005 Oct. 45(9):1267-70. [Medline].

  8. Cheshire WP Jr. The shocking tooth about trigeminal neuralgia. N Engl J Med. 2000 Jun 29. 342(26):2003. [Medline].

  9. Cheshire WP Jr, Wharen RE Jr. Trigeminal neuralgia in a patient with spontaneous intracranial hypotension. Headache. 2009 May. 49(5):770-3. [Medline].

  10. Penman J. Trigeminal neuralgia. In: Vinkin PJ, Bruyn GW, eds. Handbook of Clinical Neurology. Vol 55. 1968:296-322.

  11. Mauskop A. Trigeminal neuralgia (tic douloureux). J Pain Symptom Manage. 1993 Apr. 8(3):148-54. [Medline].

  12. Rushton JG, Olafson RA. Trigeminal neuralgia associated with multiple sclerosis. A case report. Arch Neurol. 1965 Oct. 13(4):383-6. [Medline].

  13. Jensen TS, Rasmussen P, Reske-Nielsen E. Association of trigeminal neuralgia with multiple sclerosis: clinical and pathological features. Acta Neurol Scand. 1982 Mar. 65(3):182-9. [Medline].

  14. Limonadi FM, McCartney S, Burchiel KJ. Design of an artificial neural network for diagnosis of facial pain syndromes. Stereotact Funct Neurosurg. 2006. 84(5-6):212-20. [Medline].

  15. Fromm GH, Terrence CF, Chattha AS, Glass JD. Baclofen in trigeminal neuralgia: its effect on the spinal trigeminal nucleus: a pilot study. Arch Neurol. 1980 Dec. 37(12):768-71. [Medline].

  16. Patten J. Trigeminal neuralgia. In: Neurological Differential Diagnosis. 2nd ed. London: Springer. 1996:373-5.

  17. Sands GH. Pain in the face. Headaches in Adults, Annual Course, American Academy of Neurology Annual Meeting. 1994. 3:146:130-2.

  18. Eller JL, Raslan AM, Burchiel KJ. Trigeminal neuralgia: definition and classification. Neurosurg Focus. 2005 May 15. 18(5):E3. [Medline].

  19. Türp JC, Gobetti JP. Trigeminal neuralgia versus atypical facial pain. A review of the literature and case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996 Apr. 81(4):424-32. [Medline].

  20. Vincent M. SUNCT, lacrimation, and trigeminal neuralgia. Cephalalgia. 1998 Mar. 18(2):71. [Medline].

  21. Goadsby PJ, Lipton RB. A review of paroxysmal hemicranias, SUNCT syndrome and other short-lasting headaches with autonomic feature, including new cases. Brain. 1997 Jan. 120 (Pt 1):193-209. [Medline].

  22. Majoie CB, Hulsmans FJ, Castelijns JA, Verbeeten B Jr, Tiren D, van Beek EJ, et al. Symptoms and signs related to the trigeminal nerve: diagnostic yield of MR imaging. Radiology. 1998 Nov. 209(2):557-62. [Medline].

  23. Gronseth G, Cruccu G, Alksne J, Argoff C, Brainin M, Burchiel K, et al. Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology. 2008 Oct 7. 71(15):1183-90. [Medline].

  24. Tanaka T, Morimoto Y, Shiiba S, Sakamoto E, Kito S, Matsufuji Y, et al. Utility of magnetic resonance cisternography using three-dimensional fast asymmetric spin-echo sequences with multiplanar reconstruction: the evaluation of sites of neurovascular compression of the trigeminal nerve. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005 Aug. 100(2):215-25. [Medline].

  25. Cruccu G, Biasiotta A, Galeotti F, Iannetti GD, Truini A, Gronseth G. Diagnostic accuracy of trigeminal reflex testing in trigeminal neuralgia. Neurology. 2006 Jan 10. 66(1):139-41. [Medline].

  26. Eller JL, Raslan AM, Burchiel KJ. Trigeminal neuralgia: definition and classification. Neurosurg Focus. 2005 May 15. 18(5):E3. [Medline].

  27. Blom S. Trigeminal neuralgia: its treatment with a new anticonvulsant drug (G-32883). Lancet. 1962 Apr 21. 1:839-40. [Medline].

  28. Dalessio DJ. Trigeminal neuralgia. A practical approach to treatment. Drugs. 1982 Sep. 24(3):248-55. [Medline].

  29. Campbell FG, Graham JG, Zilkha KJ. Clinical trial of carbazepine (tegretol) in trigeminal neuralgia. J Neurol Neurosurg Psychiatry. 1966 Jun. 29(3):265-7. [Medline]. [Full Text].

  30. Rockliff BW, Davis EH. Controlled sequential trials of carbamazepine in trigeminal neuralgia. Arch Neurol. 1966 Aug. 15(2):129-36. [Medline].

  31. Beydoun A. Safety and efficacy of oxcarbazepine: results of randomized, double-blind trials. Pharmacotherapy. 2000 Aug. 20(8 Pt 2):152S-158S. [Medline].

  32. Sist T, Filadora V, Miner M, Lema M. Gabapentin for idiopathic trigeminal neuralgia: report of two cases. Neurology. 1997 May. 48(5):1467. [Medline].

  33. Khan OA. Gabapentin relieves trigeminal neuralgia in multiple sclerosis patients. Neurology. 1998 Aug. 51(2):611-4. [Medline].

  34. Solaro C, Lunardi GL, Capello E, et al. An open-label trial of gabapentin treatment of paroxysmal symptoms in multiple sclerosis patients. Neurology. 1998 Aug. 51(2):609-11. [Medline].

  35. Chogtu B, Bairy KL, Smitha D, Dhar S, Himabindu P. Comparison of the efficacy of carbamazepine, gabapentin and lamotrigine for neuropathic pain in rats. Indian J Pharmacol. 2011 Sep. 43(5):596-8. [Medline]. [Full Text].

  36. Carrazana EJ, Schachter SC. Alternative uses of lamotrigine and gabapentin in the treatment of trigeminal neuralgia. Neurology. 1998 Apr. 50(4):1192. [Medline].

  37. Lunardi G, Leandri M, Albano C, et al. Clinical effectiveness of lamotrigine and plasma levels in essential and symptomatic trigeminal neuralgia. Neurology. 1997 Jun. 48(6):1714-7. [Medline].

  38. Zakrzewska JM, Chaudhry Z, Nurmikko TJ, et al. Lamotrigine (lamictal) in refractory trigeminal neuralgia: results from a double-blind placebo controlled crossover trial. Pain. 1997 Nov. 73(2):223-30. [Medline].

  39. Loeser JD. The management of tic douloureux. Pain. 1977 Apr. 3(2):155-62. [Medline].

  40. Braham J. Pain in the face. Br Med J. 1968 Aug 3. 3(5613):316. [Medline]. [Full Text].

  41. Raskin NH. Trigeminal neuralgia. 2nd ed. 1988.

  42. He L, Wu B, Zhou M. Non-antiepileptic drugs for trigeminal neuralgia. Cochrane Database Syst Rev. 2006 Jul 19. 3:CD004029. [Medline].

  43. Baker KA, Taylor JW, Lilly GE. Treatment of trigeminal neuralgia: use of baclofen in combination with carbamazepine. Clin Pharm. 1985 Jan-Feb. 4(1):93-6. [Medline].

  44. Fromm GH, Terrence CF, Chattha AS. Baclofen in the treatment of trigeminal neuralgia: double-blind study and long-term follow-up. Ann Neurol. 1984 Mar. 15(3):240-4. [Medline].

  45. Parekh S, Shah K, Kotdawalla H. Baclofen in carbamazepine resistant trigeminal neuralgia - a double-blind clinical trial. Cephalalgia. 1989. 9 (Suppl 10):392-3.

  46. Fromm GH, Terrence CF. Comparison of L-baclofen and racemic baclofen in trigeminal neuralgia. Neurology. 1987 Nov. 37(11):1725-8. [Medline].

  47. Gilron I, Booher SL, Rowan MS, et al. A randomized, controlled trial of high-dose dextromethorphan in facial neuralgias. Neurology. 2000 Oct 10. 55(7):964-71. [Medline].

  48. Allam N, Brasil-Neto JP, Brown G, Tomaz C. Injections of botulinum toxin type a produce pain alleviation in intractable trigeminal neuralgia. Clin J Pain. 2005 Mar-Apr. 21(2):182-4. [Medline].

  49. DMKG study group. Misoprostol in the treatment of trigeminal neuralgia associated with multiple sclerosis. J Neurol. 2003 May. 250(5):542-5. [Medline].

  50. Tatli M, Satici O, Kanpolat Y, Sindou M. Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes. Acta Neurochir (Wien). 2008 Mar. 150(3):243-55. [Medline].

  51. [Guideline] International RadioSurgery Association. Stereotactic radiosurgery for patients with intractable typical trigeminal neuralgia who have failed medical management. Harrisburg, Pa: IRSA; 2009. (Radiosurgery practice guideline report; no. 1-03). Available at Accessed: April 8, 2011.

  52. Sweet WH. Percutaneous methods for the treatment of trigeminal neuralgia and other faciocephalic pain; comparison with microvascular decompression. Semin Neurol. 1988 Dec. 8(4):272-9. [Medline].

  53. Pollock BE, Ecker RD. A prospective cost-effectiveness study of trigeminal neuralgia surgery. Clin J Pain. 2005 Jul-Aug. 21(4):317-22. [Medline].

  54. Olson S, Atkinson L, Weidmann M. Microvascular decompression for trigeminal neuralgia: recurrences and complications. J Clin Neurosci. 2005 Sep. 12(7):787-9. [Medline].

  55. Barbor, M. MVD Bests Gamma Knife for Pain in Trigeminal Neuralgia. Medscape Medical News. Available at October 5, 2015; Accessed: October 22, 2015.

  56. Zakrzewska JM, Thomas DG. Patient's assessment of outcome after three surgical procedures for the management of trigeminal neuralgia. Acta Neurochir (Wien). 1993. 122(3-4):225-30. [Medline].

  57. Asplund P, Blomstedt P, Bergenheim AT. Percutaneous Balloon Compression vs Percutaneous Retrogasserian Glycerol Rhizotomy for the Primary Treatment of Trigeminal Neuralgia. Neurosurgery. 2015 Oct 13. [Medline].

  58. Tan LK, Robinson SN, Chatterjee S. Glycerol versus radiofrequency rhizotomy - a comparison of their efficacy in the treatment of trigeminal neuralgia. Br J Neurosurg. 1995 Apr. 9(2):165-9. [Medline].

  59. Cappabianca P, Spaziante R, Graziussi G, et al. Percutaneous retrogasserian glycerol rhizolysis for treatment of trigeminal neuralgia. Technique and results in 191 patients. J Neurosurg Sci. 1995 Mar. 39(1):37-45. [Medline].

  60. Taha JM, Tew JM Jr. Treatment of trigeminal neuralgia by percutaneous radiofrequency rhizotomy. Neurosurg Clin N Am. 1997 Jan. 8(1):31-9. [Medline].

  61. Meglio M, Cioni B. Percutaneous procedures for trigeminal neuralgia: microcompression versus radiofrequency thermocoagulation. Personal experience. Pain. 1989 Jul. 38(1):9-16. [Medline].

  62. Leksell L. Stereotactic radiosurgery in trigeminal neuralgia. Acta Chem Scand. 1971. 37:311-314.

  63. Kondziolka D, Lunsford LD, Flickinger JC, et al. Stereotactic radiosurgery for trigeminal neuralgia: a multi-institutional study using the gamma unit. J Neurosurg. 1996 Jun. 84(6):940-5. [Medline].

  64. Kondziolka D, Perez B, Flickinger JC, et al. Gamma knife radiosurgery for trigeminal neuralgia: results and expectations. Arch Neurol. 1998 Dec. 55(12):1524-9. [Medline].

  65. Deinsberger R, Tidstrand J. Linac radiosurgery as a tool in neurosurgery. Neurosurg Rev. 2005 Apr. 28(2):79-88; discussion 89-90, 91. [Medline].

  66. Kondziolka D, Lemley T, Kestle JR, Lunsford LD, Fromm GH, Jannetta PJ. The effect of single-application topical ophthalmic anesthesia in patients with trigeminal neuralgia. A randomized double-blind placebo-controlled trial. J Neurosurg. 1994 Jun. 80(6):993-7. [Medline].

  67. Türk U, Ilhan S, Alp R, Sur H. Botulinum toxin and intractable trigeminal neuralgia. Clin Neuropharmacol. 2005 Jul-Aug. 28(4):161-2. [Medline].

  68. Gilron I, Booher SL, Rowan JS, Max MB. Topiramate in trigeminal neuralgia: a randomized, placebo-controlled multiple crossover pilot study. Clin Neuropharmacol. 2001 Mar-Apr. 24(2):109-12. [Medline].

  69. Zvartau-Hind M, Din MU, Gilani A, et al. Topiramate relieves refractory trigeminal neuralgia in MS patients. Neurology. 2000 Nov 28. 55(10):1587-8. [Medline].

  70. Farago F. Trigeminal neuralgia: its treatment with two new carbamazepine analogues. Eur Neurol. 1987. 26(2):73-83. [Medline].

  71. Beydown A, et al. Meta-analysis of comparative trials of oxcarbazepine versus carbamazepine in trigeminal neuralgia. Oxcarbazepine Study Group. Poster presented at the 21st American Pain Society Annual Meeting, Baltimore, Md; Mar 14-17, 2002.

  72. Bender MT, Pradilla G, Batra S, See AP, James C, Pardo CA, et al. Glycerol rhizotomy and radiofrequency thermocoagulation for trigeminal neuralgia in multiple sclerosis. J Neurosurg. 2013 Feb. 118(2):329-36. [Medline].

  73. Jorns TP, Zakrzewska JM. Evidence-based approach to the medical management of trigeminal neuralgia. Br J Neurosurg. 2007 Jun. 21(3):253-61. [Medline].

  74. Sandell T, Eide PK. Effect of microvascular decompression in trigeminal neuralgia patients with or without constant pain. Neurosurgery. 2008 Jul. 63(1):93-9; discussion 99-100. [Medline].

  75. Truini A, Galeotti F, Haanpaa M, Zucchi R, Albanesi A, Biasiotta A, et al. Pathophysiology of pain in postherpetic neuralgia: A clinical and neurophysiological study. Pain. 2008 Oct 25. [Medline].

Illustration depicting the trigeminal nerve with its 3 main branches
Microscopic demonstration of demyelination in primary trigeminal neuralgia. A tortuous axon is surrounded by abnormally discontinuous myelin. (Electron microscope; 3300×).
Magnetic resonance image (MRI) with high resolution on the pons demonstrating the trigeminal nerve root. In this case, the patient with trigeminal neuralgia has undergone gamma-knife therapy, and the left-sided treated nerve (arrow) is enhanced by gadolinium.
Microvascular decompression (Jannetta procedure) used to treat trigeminal neuralgia. The anteroinferior cerebellar artery and the trigeminal nerve are in direct contact. Courtesy of PT Dang, CH Luxembourg
Table 1. Characteristic Features of 3 Common Craniofacial Pains
Condition Male:Female Ratio Age of onset, y Localization Accompanying Symptoms Attack Duration Cycles Provocation
Trigeminal neuralgia 1:2 >50 Unilateral None Seconds Month intervals Trigger zones
Cluster headache 31:1 30-40 Always unilateral Horner syndrome, conjunctival injection, epiphora 15-180 minutes Clusters with weeks to months intervals Nocturnal attacks
Migraine 1:1 10-20 Variable Photophobia, phonophobia, gastrointestinal symptoms 4-72 hours Days to weeks intervals Variable
Table 2. Distinguishing Features Between Trigeminal Neuralgia and Atypical Facial Pain
Feature Trigeminal Neuralgia Atypical Facial Pain
Prevalence Rare Common
Main location Trigeminal area Face, neck, ear
Pain duration Seconds to 2 minutes Hours to days
Character Electric jerks, stabbing Throbbing, dull
Pain intensity Severe Mild to moderate
Provoking factors Light touch, washing, shaving, eating, talking Stress, cold
Associated symptoms None Sensory abnormalities
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.