Authors recommendations

Care needs to be taken in eliciting and recording the clinical features of trigeminal neuralgia so the correct treatment is offered. The first-line drug should be carbamazepine but as soon as it loses efficacy or becomes poorly tolerated, other drugs such as oxcar-bazepine should be used. Patients should be investigated with MRI and referred for an early surgical opinion so they have time to think through the variety of treatment options available. In patients who are medically fit and have a identifiable compression on MRI, microvascular decompression is the most satisfactory procedure when performed by a skilled neurosurgeon.

Whenever possible, patients should be provided with information about patient support groups and the range of literature that is available to them. A well-informed patient is likely to achieve better pain control and be more satisfied with outcomes.

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