Question 1

A patient diagnosed with trigeminal neuralgia has tried several medication regimens to control pain without success. What is the next step in management for this condition?&#10;A) Consultation with a psychiatrist&#10;B) Education about alternative treatments&#10;C) Recommending a pain center&#10;D) Referral to a neurosurgeon

Accepted Answer

Referral to a neurosurgeon is the next step in management for trigeminal neuralgia when medication regimens have failed. Neurosurgical procedures, such as microvascular decompression, can be effective in treating trigeminal neuralgia by relieving pressure on the affected nerve.

Question 2

A patient is diagnosed with trigeminal neuralgia and reports having paroxysms several times each day. What is the initial treatment for this patient?&#10;A) A combination of baclofen, lamotrigine, and phenytoin&#10;B) A high dose of carbamazepine with subsequent titration downward&#10;C) Botox injections or intranasal lidocaine as needed&#10;D) Low doses of anticonvulsants with gradual increase as needed

Accepted Answer

The initial treatment for trigeminal neuralgia is a high dose of carbamazepine, which is effective in up to 80% of patients. The dose is subsequently titrated downward based on clinical response and side effects. A combination of baclofen, lamotrigine, and phenytoin or low doses of anticonvulsants may also be used, but are generally not considered first-line therapy. Botox injections or intranasal lidocaine may provide some relief, but are typically not recommended as initial treatment options.

Question 3

A patient reports paroxysms of burning, shock-like pain on both sides of the face usually triggered by chewing or talking. The provider suspects trigeminal neuralgia. Based on these presenting symptoms, what testing is indicated?

A) Autoimmune laboratory panel
B) Inflammatory markers
C) Magnetic resonance imaging (MRI)
D) Plain radiographs

C

Accepted Answer

Magnetic resonance imaging (MRI) is indicated to evaluate for structural abnormalities that may be causing the trigeminal neuralgia, such as a tumor or blood vessel pressing on the trigeminal nerve. Autoimmune laboratory panel and inflammatory markers are not typically indicated for evaluating trigeminal neuralgia. Plain radiographs do not provide sufficient detail to evaluate for possible causes of trigeminal neuralgia.

Deck 183: Trigeminal Neuralgia