Trigeminal Neuralgia

Posted On April 6, 2020

• Unilateral electric shock like pain
• involves one or more division of Trigeminal nerve
• over 80% caused by an aberrant loop of artery
• Less common: acoustic neuroma, meningioma, cyst, rarely an aneurysm or avm
• Treatment
  • Carbamazepine, (Tegretol) most studied and effective. Start 100 to 200 mg bid, up to max of 1200 mg per day
  • Oxycarbazepine (Trileptal), start 300 mg bid
  • Possibly effective: baclofen, lamotrigine, pimozide
    • baclofen 5 mg tid, upt to 60 mg per day
    • lamotrigine 25 mg qd, increase by 25 mg daily every weekly, target dose 200 mg bid. Reduce dose if patient taking valproate.
    • Pimozide, a dopamine agonist, seldom used due to potential side effects.
  • Limited data: clonazepam, gabapentin, tizanidine, valproate
  • Failed Carbamazepine: may try combination with gabapentin, lamotrigine, baclofen or tizanidine.
  • Surgical treatment
    • Microvascular decompression
      • involves craniotomy
      • initial pain relief 90%
      • pain free rates decline to about 70% in 5 years
    • Ablative procedures