Medical management of trigeminal neuralgia.

Trigeminal neuralgia is a sudden, severe, brief, recurrent stabbing pain in the distribution of the trigeminal nerve whose aetiology remains unknown. Medical management is the first line of treatment and when this fails, surgical treatment needs to be undertaken. Carbamazepine is the best anti-neuralgic drug available at present, but may cause unacceptable side-effects. Phenytoin, baclofen and clonazepam are other drugs used, either as monotherapy or together with carbamazepine, but they are not as effective. Oxcarbazepine, a new drug, similar to carbamazepine but with fewer side-effects, may prove to be the drug of the future. Once diagnosed, these patients should be managed by specialists who can offer a range of treatments.