Trigeminal neuralgia is characterized by paroxysms of severe unilateral pain in the trigeminal nerve distribution lasting only seconds, with normal findings on neurologic examination. There is no pain between paroxysms. Treatment can be medical or surgical. Carbamazepine is a very effective treatment. If it fails, the patient is unlikely to have trigeminal neuralgia. Patients with trigeminal neuralgia may present to the ED because symptoms are of recent onset or recurrent, and they should be started or restarted on carbamazepine. Pain control is rarely an issue, since the paroxysms are so brief. Patients with intractable symptoms despite medical therapy should be referred to a neurologist or neurosurgeon.
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