Question

Medical management of trigeminal neuralgia. [5]

Hint:

If medical management is ineffective, surgical options such as microvascular decompression may be considered for long-term relief.

Answer 1

Trigeminal neuralgia is characterized by sudden, severe, stabbing pain along the trigeminal nerve distribution. Medical management primarily involves the use of anticonvulsants and other medications to manage the pain.
Step 1: First-line Medications:
1. Carbamazepine: This is the most commonly used drug for trigeminal neuralgia. It works by inhibiting the sodium channels in neurons and reducing nerve excitability.
2. Oxcarbazepine: An alternative to carbamazepine, it has a similar mechanism of action and fewer side effects.
Step 2: Second-line Medications:
1. Gabapentin or Pregabalin: These drugs, which are GABA analogs, can be effective for pain relief in cases where carbamazepine is not well tolerated or ineffective.
2. Baclofen: A muscle relaxant that can help reduce pain by inhibiting the release of excitatory neurotransmitters at the synaptic level.
Step 3: Adjunctive Therapies:
1. Tricyclic Antidepressants (TCAs): Medications like amitriptyline may be used in cases where pain is more persistent.
2. Topical Lidocaine: In some patients, a topical anesthetic applied to the affected area may provide temporary relief.