All trigeminal neuralgia patients should undergo medical therapy initially as many patients respond very well to medications. Anti-seizure medications work well in treating trigeminal neuralgia. The best medication for trigeminal neuralgia is Tegretol (Carbamazepine) which relieves trigeminal neuralgia in about 60% of patients initially. Other trigeminal neuralgia medications include, either as a single agent or in combination, Dilantin, Neurontin, Baclofen and Keppra. Success rates for these medications are in the range of 30-40%.
For many patients, toxicity (e.g. bone marrow and liver toxicity for Tegretol) and side-effects (drowsiness, dizziness, imbalance for all trigeminal neuralgia medications) are not insignificant, and when taking Tegretol, blood tests are required on a regular basis to monitor the liver and bone marrow functions as well as the blood drug level.
Medical therapy must be closely monitored to achieve the goal of pain relief while minimizing side-effects. At times, when treating trigeminal neuralgia that is refractory to a single agent, a second (or third) medication may be added to adequately control trigeminal neuralgia as long as there is not a significant extent of side-effects.