neurologic disorders
Trigeminal Neuralgia
Key Points
Trigeminal neuralgia is usually caused by compression by an intracranial artery. The characteristic paroxysmal, lancinating, excruciating, and sometimes incapacitating pain is often pathognomonic. Treat withcarbamazepine, which is usually effective for long periods; ifcarbamazepineis ineffective or has adverse effects, try another drug (eg,oxcarbazepine,lamotrigine,gabapentin,baclofen,pregabalin). If severe pain persists despite these measures, consider microvascular decompression or neuroablative treatments; however, efficacy may be temporary, and improvement may be followed by recurrent pain that is more severe than the preceding episodes. 