Feature Article

Management of trigeminal neuralgia and its atypical variant

Helen Boocock, E Russell Vickers
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Although trigeminal neuralgia is relatively uncommon, the recurrent and sometimes chronic pain associated with the condition can result in negative psychosocial behaviours, such as anxiety and depression. Anticonvulsant drugs are first-line treatment for the classic form of trigeminal neuralgia.

Key Points

  • Trigeminal neuralgia is characterised by sharp paroxysmal pain radiating through the face, teeth and jaw.
  • Pain from classic trigeminal neuralgia is episodic in nature, whereas atypical trigeminal neuralgia has persistent pain as its distinguishing quality.
  • Anticonvulsants are the treatment of choice for the classic form of trigeminal neuralgia, with carbamazepine being the gold standard.
  • Amitriptyline is first-line treatment for atypical trigeminal neuralgia.
  • Several surgical and ablative procedures can be used to treat trigeminal neuralgia.
  • Classic trigeminal neuralgia that is initially well controlled with a single anticonvulsant may progress to a complex pain state involving neuralgic pain, neuropathic pain, sympathetically maintained pain and/or musculoskeletal pain.