Intended for healthcare professionals


Treatment options for trigeminal neuralgia

BMJ 2003; 327 doi: (Published 11 December 2003) Cite this as: BMJ 2003;327:1360
  1. Andria F A Merrison, specialist registrar,
  2. Geraint Fuller, consultant neurologist (
  1. Department of Neurology, Gloucestershire Royal Hospital, Gloucester GL1 3NN
  2. Department of Neurology, Gloucestershire Royal Hospital, Gloucester GL1 3NN

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

    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 …

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