Table 20 Treatment of trigeminal neuralgia

Primarily prophylactic pharmacological treatment with anti-epileptics

Normally, weak analgesics and opioids have no effect

Spontaneous remission is frequent. If the patient has been pain-free for 3–4 weeks, gradual discontinuation of medical management may be considered

In case of acute aggravation, where the patient has problems ingesting food, attacks may be interrupted with a fosphenytoin or lidocaine infusion

In case of unsatisfactory effect from medical treatment, a decision should be made with regard to neurosurgical treatment (microvascular decompression or lesion treatment)

The decision on neurosurgical treatment should be made as quickly as possible to avoid development of a chronic neuropathic pain condition.