Guidelines for daily clinical management of patients with trigeminal neuralgia were published in 2019 by the European Academy of Neurology.
Use the most recent classification system, which diagnoses trigeminal neuralgia (TN) as primary TN, either classical or idiopathic depending on the degree of neurovascular contact, or as secondary TN caused by pathology other than neurovascular contact.
All TN patients should undergo MRI.
If MRI is contraindicated, trigeminal reflex testing should be used to distinguish secondary from primary TN.
If MRI does not demonstrate any neurovascular contact neuroablative treatments are the preferred choice.
Carbamazepine (200-1200 mg/day) and oxcarbazepine (300-1800 mg/day) should be used as first-line prophylactic treatments of TN.
Lamotrigine, gabapentin, botulinum toxin type A, pregabalin, baclofen, and phenytoin may be used either alone or as add-on therapy.
Intravenous infusion of fosphenytoin or lidocaine can be used for acute pain.
Patients should be offered surgery if pain is not sufficiently controlled medically or if medical treatment is poorly tolerated.
In patients with classical TN, microvascular decompression is recommended as first-line surgery.
TN patients should be offered psychological and nursing support.
For more Clinical Practice Guidelines, go to Guidelines.
For more information, go to Trigeminal Neuralgia.
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Cite this: Trigeminal Neuralgia Clinical Practice Guidelines (2019) - Medscape - Aug 01, 2019.