Abstract

INTRODUCTION

Trigeminal neuralgia is a severe, debilitating facial pain disorder that has driven some to suicide when unable to obtain relief. Afflicted patients often describe the pain as ‘shocking’, ‘lightning’, or ‘electric’. If a patient describes pain in the face with words such as these, the diagnosis of trigeminal neuralgia should be at the top of the differential diagnosis.

Historically, treatment has ranged from poultices and salves to injecting boiling water into the cheek to kill the nerve. The introduction of carbamazepine brought successful medical management to many, but adverse effects, and gradual development of refractory pain, mean that some patients still require invasive procedures to achieve pain control. The goal is to identify the point at which surgical intervention should be considered, and then to guide the choice of procedure.

MEDICAL MANAGEMENT

First line therapy for trigeminal neuralgia is carbamazepine (Tegretol). If the patient cannot tolerate carbamazepine, other anticonvulsants