A 56-year-old male, diabetic, is presenting with recurrent brief headache for 3 weeks, affecting one side of the head and almost always around mouth, increasing with eating and loud laughing and resolves in minutes. On examination his temperature is 37.1C, random capillary glucose is 7.5 mmol/l, and his blood pressure is 110/70 mmHg. No neck stiffness, skin rash, or facial oedema. What is the most appropriate treatment?
Trigeminal neuralgia usually presents with paroxysms of intense, stabbing pain, in the trigeminal nerve distribution, typically affecting the mandibular or maxillary divisions on one side. It can be triggered with Washing the affected area, shaving, eating, and laughing. It’s more common in males above 50 years old. Diagnosis depends on looking for a secondary cause Compressing the trigeminal root by anomalous or aneurysmal intracranial vessels or a tumour, zoster, or skull base malformation. MRI Is necessary to exclude secondary causes. Carbamazepine is the first line treatment. Surgery may be needed in refractory cases.