New Guidelines for Diagnosis, Treatment of Facial Pain

THURSDAY, Aug. 21 (HealthDay News) -- Trigeminal neuralgia, which causes intense facial pain, can be diagnosed by head imaging and testing of the trigeminal nerves and treated by drugs or surgery, according to guidelines published online Aug. 20 in Neurology and simultaneously in the European Journal of Neurology.

Gary S. Gronseth, M.D., from the University of Kansas in Kansas City, and colleagues reviewed the literature to determine how best to diagnose and treat trigeminal neuralgia.

The researchers found that routine head imaging by computed tomography or MRI identifies structural causes in 15 percent of cases and thus may be useful. Symptomatic trigeminal neuralgia may be identified by the presence of trigeminal sensory deficits or bilateral involvement of the trigeminal nerves but not excluded by their absence due to poor specificity. The measurement of trigeminal reflexes may be useful in distinguishing the symptomatic from the classical form of trigeminal neuralgia, the report indicates.

"Carbamazepine (Level A) or oxcarbazepine (Level B) should be offered for pain control while baclofen and lamotrigine (Level C) may be considered useful. For patients with trigeminal neuralgia refractory to medical therapy, Gasserian ganglion percutaneous techniques, gamma knife and microvascular decompression may be considered (Level C). The role of surgery versus pharmacotherapy in the management of trigeminal neuralgia in patients with multiple sclerosis remains uncertain," the authors write.

Several of the study authors report financial relationships with the pharmaceutical industry.

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