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Diagnosed with trigeminal neuralgia. Was on carbamezabine. Changed to nuerontin. How to reduce the pain?

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I was diagnosed with trigeminal neuralgia on the left side of my face in December of 2011. I was put on carbamezabine, but could only take 400 milagrams daily as anything more made me sick. I have recently been put on nuerontin, 900 milagrams a day plus the 400 carbamezapine as well, and am seeing no improvement in my condition. I am constantly in pain, and now it has started to act up on the right side of my face. Why is the medication not working, and what else could be wrong?
Posted Sun, 3 Nov 2013 in Brain and Spine
Answered by Dr. Anjana Rao Kavoor 1 hour later
Brief Answer:
Please find detailed answer below

Detailed Answer:
Thanks for writing in to us.

You might be having Trigeminal Neuralgia refractory to Carbamazepine or Oxycarbazepine. Many patients experience this and need to search other treatment options.

Research has been done in this area and latest literature done in 2013 suggests the following:

The guidelines on trigeminal neuralgia management published by the American Academy of Neurology (AAN) and the European Federation of Neurological Societies (EFNS) recommended that patients unresponsive to carbamazepine or oxcarbazepine be offered the surgical option.

However, because some patients may not be willing to resort to surgery, research of literature for treatment in refractory trigeminal neuralgia was done. It was found other oral treatments, intranasal spray, subcutaneous injections, various kinds of peripheral nerve blocks and injections of botulinum toxin.

On the basis of the available evidence it is suggested that no oral treatment other than carbamazepine or oxcarbazepine is useful. Among the other options, there is increasingly strong evidence that botulinum toxin injections are efficacious and may be offered before surgery or to those unwilling to undergo surgery.

I hope this helps.
Do write back in case of doubts.

Dr.A.Rao Kavoor
Above answer was peer-reviewed by
Follow-up: Diagnosed with trigeminal neuralgia. Was on carbamezabine. Changed to nuerontin. How to reduce the pain? 1 hour later
I am told if the pain i experience is now on both sides of my face that it may not be trigeminal neuralgia, is this correct? What else could i have with the same symptoms of Trigeminal neuralgia?

Thank you.
Answered by Dr. Anjana Rao Kavoor 20 minutes later
Brief Answer:
Differential diagnosis of Trigeminal Neuralgia

Detailed Answer:
You are welcome and thanks for writing in with an update.

Based on The International Classification of Headache Disorders the criteria in making a diagnosis of Trigeminal neuralgia include the following:

1. Paroxysmal attacks of pain, lasting a second to two minutes and affecting one or more divisions of trigeminal nerve (typically maxillary or mandibular branches).
2. Pain has at least one of the following characteristics: intense, sharp, superficial, stabbing, precipitated by trigger areas/factors.
3. Attacks are similar in individual patients.
4. There is no neurological deficit on examination.
5. It is not caused by another disorder.

The other disorders presenting in the same way as Trigeminal neuralgia are
1. Dental pathology.
2. Temporomandibular joint dysfunction.
3. Migraine.
4. Temporal arteritis (TN rarely affects the forehead alone).
5. Cluster headaches.
6. MS and other disorders of myelin.
7. Overlying aneurysm of a blood vessel.
8. Tumour in posterior fossa, eg meningiomas.
9. Arachnoid cyst at the cerebellopontine angle.
10. Postherpetic neuralgia after shingles

Please note that each of the above disorders has a specific clinical feature.

I hope this helps.
Do write back in case of doubts.

Dr.A.Rao Kavoor
Above answer was peer-reviewed by
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