This is an excellent overview. I hoped to add my personal experiences in the difficult but not uncommon situation of the very elderly patient who is admitted because of pain and inability to eat and/or drink. I also have positive experiences with phenytoin, the only agent probably available IV. Another option the authors do not mention but with some evidence base is botulinum toxin, a very small dose (25 IU) subcutaneous in the area of pain (see e.g. J Headache Pain. 2013 Aug 21;14(1):72. Therapeutic efficacy and safety of botulinum toxin type A in trigeminal neuralgia: a systematic review. Hu Y, Guan X, Fan L, Li M, Liao Y, Nie Z, Jin L.)
When stuck with these patients these are worthwhile options.
Rapid Response:
Re: Trigeminal neuralgia
This is an excellent overview. I hoped to add my personal experiences in the difficult but not uncommon situation of the very elderly patient who is admitted because of pain and inability to eat and/or drink. I also have positive experiences with phenytoin, the only agent probably available IV. Another option the authors do not mention but with some evidence base is botulinum toxin, a very small dose (25 IU) subcutaneous in the area of pain (see e.g. J Headache Pain. 2013 Aug 21;14(1):72. Therapeutic efficacy and safety of botulinum toxin type A in trigeminal neuralgia: a systematic review. Hu Y, Guan X, Fan L, Li M, Liao Y, Nie Z, Jin L.)
When stuck with these patients these are worthwhile options.
Competing interests: No competing interests