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Trigeminal neuralgia
What's new
The American Academy of Family Physicians (AAFP) has released a rapid evidence review on trigeminal neuralgia. Brain MRI is recommended when trigeminal neuralgia is suspected to rule out alternative causes of symptoms, such as multiple sclerosis or tumors. Carbamazepine is recommended as the first-line treatment. Surgical intervention can be considered for symptom relief in patients with refractory trigeminal neuralgia despite pharmacologic therapy. .
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of trigeminal neuralgia are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2025) and the European Academy of Neurology (EAN 2019).
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Diagnostic investigations
Physical examination: as per EAN 2019 guidelines, do not use clinical characteristics to exclude secondary trigeminal neuralgia.
D
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MRI
Medical management
General principles
As per EAN 2019 guidelines:
Attempt medical management before offering surgery for trigeminal neuralgia.
B
Treat patients with secondary trigeminal neuralgia similar to patients with primary trigeminal neuralgia.
B
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Management of acute exacerbations
Long-term management