From the Guidelines
Trigeminal neuralgia affecting the lower jawline should be treated with carbamazepine (CBZ) as the first-line agent, starting at 200 mg at night and gradually increasing by 200 mg every 7 days to a final dose of 400–1200 mg, divided in 2–3 doses per day, due to its proven efficacy in providing partial or complete pain relief in 70% of patients 1.
Causes of Trigeminal Neuralgia
The causes of unilateral intermittent trigeminal neuralgia affecting the lower jawline include:
- Compression of the trigeminal nerve by blood vessels
- Demyelinating conditions like multiple sclerosis
- Tumors
- Trauma These causes can lead to the characteristic electric shock-like pain episodes that are typical of this condition 1.
Treatment Options
Treatment options for trigeminal neuralgia include:
- Medications:
- Carbamazepine (Tegretol) is the primary drug of choice, with a recommended starting dose of 200 mg at night, gradually increasing to 400–1200 mg, divided in 2–3 doses per day 1
- Alternative medications include oxcarbazepine (Trileptal), gabapentin (Neurontin), or baclofen
- Surgical options:
- Microvascular decompression
- Gamma knife radiosurgery
- Percutaneous procedures It is essential to consult a neurologist or pain specialist for further evaluation and treatment options if medication fails to provide relief after 2-3 weeks of adequate dosing.
Management of Painful Episodes
During painful episodes, it is recommended to:
- Avoid triggers like touching the face, chewing on the affected side, exposure to cold air, or consuming hot/cold foods
- Apply warm compresses to the jaw area for temporary relief The intermittent nature of this condition is typical, with episodes often lasting seconds to minutes, characterized by electric shock-like pain 1.
From the FDA Drug Label
Trigeminal Neuralgia Carbamazepine tablets are indicated in the treatment of the pain associated with true trigeminal neuralgia. Beneficial results have also been reported in glossopharyngeal neuralgia. Initial:On the first day, 100 mg twice a day for tablets for a total daily dose of 200 mg This daily dose may be increased by up to 200 mg/day using increments of 100 mg every 12 hours for tablets, only as needed to achieve freedom from pain. Do not exceed 1200 mg daily. Maintenance:Control of pain can be maintained in most patients with 400 to 800 mg daily.
The causes of unilateral intermittent trigeminal neuralgia are not specified in the provided drug labels. The treatment option for unilateral intermittent trigeminal neuralgia affecting the lower jawline is carbamazepine. The initial dose is 100 mg twice a day, and the dose may be increased by up to 200 mg/day as needed to achieve freedom from pain, not exceeding 1200 mg daily. The maintenance dose is typically 400 to 800 mg daily 2.
From the Research
Causes of Unilateral Intermittent Trigeminal Neuralgia
- The condition is characterized by recurrent attacks of lancinating pain in the trigeminal nerve distribution, typically triggered by talking, chewing, teeth brushing, shaving, a light touch, or even a cool breeze 3
- Vascular compression of the trigeminal nerve or a tumor process can cause trigeminal neuralgia, leading to nerve demyelination and abnormal depolarization 4
- Pressure on the nerve itself causes nerve demyelination, resulting in the development of ectopic impulses 4
Treatment Options for Unilateral Intermittent Trigeminal Neuralgia
- Medical treatment is the initial approach, with carbamazepine being the drug of choice 5, 6, 3, 4
- Alternative medications to carbamazepine include gabapentin, pregabalin, and microgabalin, as well as baclofen, lamotrigine, intravenous lidocaine, and botulinum toxin type A 7
- Surgical options are available if medications are no longer effective or tolerated, including microvascular decompression, gamma knife radiosurgery, and percutaneous rhizotomies 5, 6, 4
- Other techniques to be considered include glycerol rhizotomy, balloon compression, partial sensory trigeminal rhizotomy, and peripheral neurectomy 6
Considerations for Treatment
- Accurate and prompt diagnosis is important because the pain of trigeminal neuralgia can be severe 3
- Brain imaging is required to exclude secondary causes, such as multiple sclerosis or a tumor process 5, 4
- Patients offered surgical treatments require data on the track record of the relevant institution in performing that procedure 6
- Adverse effects of drugs, such as drowsiness, dizziness, rash, bone marrow suppression, and liver dysfunction, should be considered when selecting a treatment option 7