The medical and surgical management of trigeminal neuralgia

Trigeminal neuralgia is a paroxysmal and severely disabling facial pain. The diagnosis is usually made on the basis of a typical history and the exclusion of secondary causes. Initial management of the pain is medical. Carbamazepine is the drug of choice although some patients respond to other drugs including phenytoin, baclofen, sodium valproate and clonazepam. Surgical therapy should be considered if medical treatment fails or cannot be tolerated. Surgical options include peripheral or central (intracranial) procedures. Central procedures have greater morbidity and a significant mortality rate (approximately 1%) but the success rates are much greater. Physicians should be aware of the potential benefits of surgery but all patients should be advised carefully about the risks before informed consent is given.