Trigeminal Neuralgia

Change Language German

Clinical Presentation

  • Sudden, shooting, intense pain in the face, repeatedly occurring unilaterally in the same location
    • Pain lasts for a few seconds and may occur in clusters
    • Most commonly in the cheek and jaw (V2/V3), less commonly in the forehead (V1)
    • Often triggered by chewing movements, touches, etc.


  • Typically a clinical diagnosis based on typical symptoms
  • If suspected lesion along the trigeminal nerve, request MRI:
    • MRI head/brainstem: Coronal, sagittal, and axial, with fat suppression and 1-2 mm slices through the course of the trigeminal nerve


  • First-line
    • Carbamazepine: Initially 200-400mg (older individuals 100-200mg), increase daily by 50mg up to 800mg/day, divided into 3-4 doses/day
      • Caution: Monitor liver function and serum levels (hyponatremia), watch for allergic skin reactions, cognitive side effects
    • Gabapentin: Initially 100-300mg, increase every 2 days by 100-300mg up to the individually maximum tolerable dose (up to 3600mg/day, divided into three doses of max 1200mg each)
    • Pregabalin: Initially 75mg, increase every 3 days by 75mg up to 150-600mg/day, divided into two doses
  • Second-line
    • Clonazepam: Initially 0.25-0.5mg up to max. 6-8mg/day
    • Lamotrigine: 25mg, increase every two weeks by 25mg up to max 400mg/day
      • Caution: Watch for allergic skin reactions
    • Oxcarbazepine: Initially 150-300mg, increase every 3-5 days by 150-300mg up to 900-1800mg/day
      • Caution: Monitor for hyponatremia, allergic skin reactions
    • Valproate: Initially 300mg, increase every 2-5 days by 300mg up to 20-30mg/kg/day
      • Caution: Not recommended for women of childbearing age