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Trigeminal neuralgia: a practical guide
  1. Giorgio Lambru1,
  2. Joanna Zakrzewska2,3,
  3. Manjit Matharu4,5
  1. 1 The Headache Service, Pain Management and Neuromodulation Centre, Guy's and St Thomas' Hospitals NHS Trust, London, UK
  2. 2 Facial Pain Clinic, Eastman Dental Hospital, London, UK
  3. 3 Pain Management Centre, University College London Hospitals NHS Foundation Trust, London, UK
  4. 4 Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London, UK
  5. 5 Headache and Facial Pain Group, National Hospital for Neurology and Neurosurgery, London, UK
  1. Correspondence to Dr Manjit Matharu, Headache and Facial Pain Group, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; manjit.matharu{at}


Trigeminal neuralgia (TN) is a highly disabling disorder characterised by very severe, brief and electric shock like recurrent episodes of facial pain. New diagnostic criteria, which subclassify TN on the basis of presence of trigeminal neurovascular conflict or an underlying neurological disorder, should be used as they allow better characterisation of patients and help in decision-making regarding medical and surgical treatments. MR imaging, including high-resolution trigeminal sequences, should be performed as part of the diagnostic work-up. Carbamazepine and oxcarbazepine are drugs of first choice. Lamotrigine, gabapentin, pregabalin, botulinum toxin type A and baclofen can be used either alone or as add-on therapy. Surgery should be considered if the pain is poorly controlled or the medical treatments are poorly tolerated. Trigeminal microvascular decompression is the first-line surgery in patients with trigeminal neurovascular conflict while neuroablative surgical treatments can be offered if MR imaging does not show any neurovascular contact or where patients are considered too frail for microvascular decompression or do not wish to take the risk.

  • pain
  • trigeminal nerve
  • trigeminal neuralgia
  • headache

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  • Contributors All authors contributed to the designing, drafting and revision of the manuscript for intellectual content.

  • Funding GL and MM have not been funded by any agency in the public, commercial or not-for-profit sectors. JZ undertook the work at University College London and University College London Hospital NHS Trust who received a proportion of funding from the Department of Health's NIHR Biomedical Research Centre funding scheme.

  • Competing interests GL has received speaker honoraria, funding for travel and has received honoraria for participation in advisory boards sponsored by Allergan, Novartis, Eli Lilly and TEVA. He has received speaker honoraria, funding for travel from electroCore, Nevro Corp and Autonomic Technologies. JZ serves on the advisory board of Biogen and Eli Lilly and received payment from Biogen for design of drug trials. MM serves on the advisory board for Abbott, Allergan, Eli Lilly, Medtronic, Novartis and TEVA, and has received payment for the development of educational presentations from Allergan, electroCore, Eli Lilly, Novartis and TEVA.

  • Provenance and peer review Commissioned. Externally peer reviewed by Nick Silver, Liverpool, UK.

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