Recommendations for the management of trigeminal neuralgia

  • Bendtsen L & al.
  • Eur J Neurol
  • 12 Mar 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • The European Academy of Neurology updated recommendations for the management of patients with trigeminal neuralgia (TN).

Key recommendations

  • Diagnosis
    • MRI along with a combination of 3 high-resolution sequences should be performed in all patients to exclude secondary causes of TN.
    • MRI is strongly recommended as part of work up in patients with TN.
    • When MRI is not possible, trigeminal reflexes should be used to distinguish secondary TN from primary TN.
    • Demonstration of neurovascular contact should not be used to confirm the diagnosis of TN; it may help to decide to refer a patient for microvascular decompression (MVD).
  • Pharmacological Treatment
    • Intravenous fosphenytoin or lidocaine may be used in patients with acute exacerbations of pain.
    • Carbamazepine or oxcarbazepine is recommended for long-term treatment of TN.
    • Lamotrigine, gabapentin, botolinum toxin type A, pregabalin, baclofen and phenytoin may be used either alone or as add-on therapy.
  • Surgical Treatment
    • If pain is not tolerable or medical management is not able to control pain, surgery can be considered.
    • No preference can be given between any neuroablative treatments or between them and MVD.
    • Neuroablative treatments should be the preferred choice if any neurovascular contact is not present in MRI.
  • Management of secondary TN and non-pharmacological and non-surgical management of TN.
    • Medical treatment of patients with secondary TN should be similar to those with primary TN. Surgical interventions should consider Gasserian ganglion procedures and MVD.
    • Patients should be offered psychological and nursing support.

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