Treatment can be subdivided into pharmacologic therapy, percutaneous procedures, surgery, and radiation therapy. Adequate pharmacologic trials should always precede the contemplation of a more invasive approach. Most patients respond well to initial therapy, but some cases are resistant to any type of treatment.
Carbamazepine and oxcarbazepine are considered first-line therapy. Lamotrigine and baclofen are second-line therapy. Other treatments are third line and the evidence for their efficacy is scant.
Treatment for trigeminal neuralgia must be tailored individually, based on the patient's age and general condition. In the case of symptomatic trigeminal neuralgia, adequate treatment is that of its cause. Use of pharmacoprophylaxis or of surgical techniques used for the classic form can be tried.
•Carbamazepine (Tegretol, Carbatrol) was introduced in the 1960s and has proven its efficacy in numerous studies. It remains the criterion standard of treatment for trigeminal neuralgia. Oxcarbazepine (Trileptal) has not been studied as extensively, but efficacy outcomes are similar. Better tolerability can be considered an advantage over carbamazepine.
Lamotrigine (Lamictal) has been proven more effective than placebo. The dosage should be increased slowly for better tolerance (eg, 25-mg daily dose each week; up to 250 mg twice a day).
Baclofen has demonstrated its efficacy but with a lower degree of evidence.