The Medical Management of Trigeminal Neuralgia

Abstract

Trigeminal neuralgia results from disturbances in the trigeminal root entry zone which generate repetitive action potentials. Drugs which relieve the pain of trigeminal neuralgia depressed these potentials. Anticonvulsants which exert this or related effects, and which have been demonstrated to be efficacious in trigeminal neuralgia, include carbamazepine, phenytoin, clonazepam, and valproic acid. Baclofen may act by facilitating segmental inhibition of the trigeminal complex. The mechanism of action of pimozide for treating trigeminal neuralgia is not known. Carbamazepine is suggested as the drug of first choice; baclofen or clonazepam could be added if carbamazepine monotherapy is ineffective. When these fail, monotherapy with phenytoin, pimozide, or valproic acid would be a reasonable next step.

Clinical characteristics and economic costs of patients with painful neuropathic disorders

“…3,4,5,7,10,11,14,18,22,28,38,39,41 Use of opioids and NSAIDs, on the other hand, was widespread, with more than one half of PND patients receiving the former. These findings suggest that providers might be most comfortable prescribing "traditional" analgesics for the treatment of pain, irrespective of its underlying cause (nociceptive vs neuropathic).…”

“…2,6,13,16,20,23,24,25,27,31,35,37,40 As a result, these agents have been proposed as the mainstay of therapy for many neuropathic pain syndromes. 3,4,5,7,10,11,14,18,22,28,38,39,41 Although the nature and causes of neuropathic pain have been extensively studied, many other questions remain unanswered. For example, how do the clinical characteristics of patients with PNDs differ from those of patients without painful neuropathies?…”

Functional analysis of the α-neurotoxin, BmαTX14, derived from the Chinese scorpion, Buthus martensii Karsch

“…Na + channel blocking drugs are the first choice in treatment of trigeminal neuralgia, but clearly it is not possible for the drugs to interact with the Na + channels in the very same manner (Green and Selman 1991). Further studies on characteristics of the Na + channels are needed to identify the crucial residues of the drug-binding site.…”

Determination of a Clinical Value for the Repair Half-Time (T1/2) of the Trigeminal Nerve Based on Outcome Data from Gamma Knife Radiosurgery for Facial Pain

“…Multiple sclerosis, herpes zoster, and prior trauma or surgery may also result in facial pain (3). First-line therapy for idiopathic trigeminal neuralgia is typically medical management with anti-convulsants, and long-term complete relief is often possible (4,5). Eventually the symptoms become refractory to medical management, and some other form of therapy is necessary.…”