14.7.5
Trigeminal and Glossopharyngeal Neuralgia
Malawi Standard Treatment Guidelines, 6th Edition, 2023. Chapter 14, Oral and Maxillofacial Conditions.
Clinical Description
Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that affects the trigeminal or 5th cranial nerve, one of the most widely distributed nerves in the head.
The intensity of pain can be physically and mentally incapacitating.
Signs and Symptoms
- Unilateral pain with a trigger zone
Investigations
- CT Scan or MRI
Pharmacological
- Give Carbamazepine 100 mg 12 hourly for a month then review
- Give Phenytoin 300 mg -500 mg 12 hourly per day, can be administered by IV
- for severe TN pain
- Give Gabapentin 300 mg 8 hourly Give Baclofen 5 mg 12 hourly or 8 hourly a day which can be increased
- Usual effective dose is 50-60 mg per day
- Can be used alone or in combination with Carbamazepine
Note: If trigeminal neuralgia persists after 2 months refer to neurosurgery
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