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Cheshire WP. Trigeminal neuralgia : a guide to drug choice. CNS Drugs. 1997;7(2):98-110doi: 10.2165/00023210-199707020-00002.
Cheshire, W. P. (1997). Trigeminal neuralgia : a guide to drug choice. CNS drugs, 7(2), 98-110. https://doi.org/10.2165/00023210-199707020-00002
Cheshire, W P. "Trigeminal neuralgia : a guide to drug choice." CNS drugs vol. 7,2 (1997): 98-110. doi: https://doi.org/10.2165/00023210-199707020-00002
Cheshire WP. Trigeminal neuralgia : a guide to drug choice. CNS Drugs. 1997 Feb;7(2):98-110. doi: 10.2165/00023210-199707020-00002. PMID: 23338129.
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CNS Drugs. 1997 Feb;7(2):98-110. doi: 10.2165/00023210-199707020-00002.

Trigeminal neuralgia : a guide to drug choice.

CNS drugs

W P Cheshire

Affiliations

  1. Department of Neurology, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, Florida, 32224, USA.

PMID: 23338129 DOI: 10.2165/00023210-199707020-00002

Abstract

Trigeminal neuralgia, also known as tic douloureux, is an idiopathic condition of severe, unilateral, paroxysmal facial pain. The abrupt nature of the painful attacks (a temporal profile that is similar to that of seizures) led to the discovery that some anticonvulsant drugs are effective against neuralgia.Carbamazepine is the drug of choice, and treatment requires careful dosage titration. Baclofen, phenytoin and sodium valproate are also effective. Transient relief is sometimes possible with local anaesthetics. Limited data suggest that topical capsaicin, and tizanidine, lamotrigine, oxcarbazepine, pyridostigmine and enalapril have helped some patients. While effective, other drugs are limited by their adverse effects; for example, clonazepam is too sedating, pimozide induces extrapyramidal adverse effects, and tocainide and felbamate can cause aplastic anaemia. Phenobarbital (phenobarbitone), opioids, mexiletine, tricyclic antidepressants, corticosteroids, nonsteroidal anti-inflammatory drugs and sympatholytics are ineffective.The antineuralgic effect of any drug may eventually wear off. If this occurs, combination therapy can restore pain relief, as can the reintroduction of a previously effective drug following a drug-free interval.Similar pharmacological strategies potentially apply to other paroxysmal pain syndromes such as vagoglossopharyngeal neuralgia. Clinical overlap with multiple sclerosis or cluster headache suggests additional drugs that may be useful in specific patients. Effective neurosurgical procedures exist for patients with trigeminal neuralgia that is refractory to medications.

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