Diagnosis and treatment of cranial neuralgias

Both medical and surgical therapies may be used in the treatment of trigeminal neuralgia and glossopharyngeal neuralgia. Ordinarily, the treatment is medical; however, if a response to drugs is not forthcoming, or if the patient becomes toxic while taking medications or refuses to abide by an appropriate medical program, then surgical consultation should be obtained and the appropriate operation performed. The form and type of neurosurgical procedure will probably depend to a considerable extent on the expertise of the neurosurgeon and his training. Generally, in the elderly, the simplest procedure should be attempted first. It may be necessary to employ both medical and surgical procedures in the individual patient. The medical drug of first choice is carbamazepine. Atypical facial neuralgia is a general term used to cover a variety of head and face pains that are poorly defined and that may not deserve separate clinical status. The pathogenesis of the atypical facial neuralgias is uncertain, and multiple causation seems likely. Search for local inflammatory pathology, neoplasms, vasomotor phenomena, and depressive symptoms is indicated. Treatment should be guided by the findings.