Trigeminal Neuralgia How Can A Neurologist Help? Summary of a presentation to Dallas TN Association November 7 th, 2007 Norma Melamed, MD Hillcrest Road Suite B220 Dallas Texas

1) Make the correct diagnosis Trigeminal neuralgia (TN) is excruciating, brief, electric shock-like facial pain, occurring mostly after age 40 Multiple pain triggers: brushing teeth, chewing, talking, cold air, eating, etc Neurologic examination to rule out other causes of pain

2) Investigative testing MRI brain scan – exclude stroke, tumor, MS Magnetic Resonance Arteriogram (MRA) – exclude aneurysms, vascular malformations

3) Medical management of pain Carbamazepine, oxcarbazepine, gabapentin, pregabalin, phenytoin, valproate, lamotrigine, topiramate, clonazpam, baclofen, amitriptyline, duloxetine, are frequently prescribed

4) Advise when to consider surgery If medical treatment fails If medication side-effects are intolerable

5)Conclusion TN is a very treatable disorder that can usually be managed medically, and long-term control achieved