Trigeminal neuralgia is an extremely painful condition which causes severe electric shock-like pain in one or more branches of the trigeminal nerve. The 3 branches are mandibular, in the lower jaw, maxillary, in the upper jaw, and ophthalmic in the upper face. It is more common in the elderly and is caused by compression of the trigeminal nerve by a hardened blood vessel inside the skull, near the brainstem. Treatment consists of trials of different medications, which work for most patients, but a small percentage require a partial destruction of the nerve (with radiofrequency heat) or surgery. Surgery consists of opening the skull and placing Teflon insulation between the nerve and the blood vessel. Medications that are used for trigeminal neuralgia inlcude epilepsy drugs, such as carbamazepine (Tegretol), oxcarbazepine (Trileptal), phenytoin (Dilantin), and a muscle relaxant, baclofen (Lioresal). A recent report suggests that a newer epilepsy drug, pregabalin (Lyrica) is also effective. However, carbamazepine, phenytoin, and baclofen are available in a generic form, which makes them much less expensive than the other, branded products.
