Trigeminal Neuralgia

Trigeminal Neuralgia: Overview

Trigeminal neuralgia is a debilitating condition in which patients describe ‘lightning’ or a ‘hot poker’-like pain that is severe and follows the distribution of the trigeminal nerve. Individual episodes of pain last only seconds, but may recur repeatedly within a short period and can be triggered by minor stimuli such as light touch, eating or drinking, shaving or passing gusts of wind. It is most common in middle or older age.


Evidence suggests that the pathological basis of trigeminal neuralgia is demyelination of sensory fibres of the trigeminal nerve in the proximal (CNS) portion of the nerve root or rarely in the brain stem, most commonly due to compression of the nerve root by an overlying artery or vein.


The mainstay of therapy for trigeminal neuralgia is carbamazepine. The usual starting dose is 200–400 mg/day in divided doses, increased by 200 mg/day until relief up to a maximum of 1200 mg/day. The average dose required is 800 mg/day.

    Adapted from: Textbook of Adult Emergency Medicine E-Book. Authored By Peter Cameron, George Jelinek, Anne-Maree Kelly, Lindsay Murray, Anthony F. T. Brown. References as cited include:
  1. Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine. Acute pain management; scientific evidence, 2nd edn. Canberra: National Health and Medical Council (Australia) 2005.
  2. Friedman BW, Greenwald P, Bania TC, et al. Randomized trial of IV dexamethasone for acute migraine in the emergency department. Neurology 2007 (Epub ahead of print).
  3. Kelly AM. Specific pain syndromes: Headache. In: Mace S, Ducharme J, Murphy M, eds. Pain management and procedural sedation in the emergency department. New York: McGraw-Hill, 2006.
  4. Kelly AM, Kerr D, Clooney M. Impact of oral dexamethasone versus placebo after ED treatment of migraine with phenothiazines on the rate of recurrent headache: a randomized controlled trial. Emergency Medicine Journal 2008; 25:26–29.