BMJ  2003;327:1360-1361 (13 December), doi:10.1136/bmj.327.7428.1360

Editorial

Treatment options for trigeminal neuralgia

The evidence is poor for most non-drug options, but such treatments are needed

The first 150 words of the full text of this article appear below.

Patients describe the sudden and severe pain of trigeminal neuralgia as a "red hot needle" or "forked lightning" 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 periods of remission of months or years. 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.2 3 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 . . . [Full text of this article]

Andria F A Merrison, specialist registrar

Department of Neurology, Gloucestershire Royal Hospital, Gloucester GL1 3NN

Geraint Fuller, consultant neurologist

Department of Neurology, Gloucestershire Royal Hospital, Gloucester GL1 3NN (Geraint.Fuller@Gloucr-tr.swest.nhs.uk)


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