From the Guidelines

Trigeminal neuralgia is primarily treated with carbamazepine, with oxcarbazepine being an equally effective alternative with fewer side effects.

The first-line treatment for trigeminal neuralgia is carbamazepine, with a recommended starting dose of 200 mg at night, gradually increased by 200 mg every 7 days to a final dose of 400–1200 mg, divided in 2–3 doses per day 1.
Other drugs with some evidence of efficacy include lamotrigine, baclofen, gabapentin, and pregabalin 2.
Medical management is often limited by side effects, with many patients experiencing intolerable side effects or sub-optimal pain control 2.

Surgical interventions, such as microvascular decompression, are considered when medical management fails, with the goal of achieving 100% pain relief without the need for ongoing medication 3.
Microvascular decompression is a non-ablative procedure that involves removing vascular compression of the trigeminal nerve, with a 70% chance of being pain-free at 10 years 2.
Ablative procedures, such as radiofrequency thermocoagulation, glycerol rhizolysis, and balloon compression, are also available, but may result in facial sensory loss and pain recurrence 3.
Stereotactic radiosurgery is an ablative procedure that has shown promise in treating trigeminal neuralgia, with a minimum effective dose of 70 Gy delivered to a 4 mm target at the sensory root of the trigeminal nerve 3.

From the Research

The treatment for trigeminal neuralgia typically involves a combination of pharmacological and surgical options.

The first-line treatment for trigeminal neuralgia is pharmacological, with carbamazepine and oxcarbazepine being the most commonly used drugs 4, 5, 6, 7, 8.
These drugs are effective in most patients, but may cause undesired side effects, leading to withdrawal from treatment or dosage reduction 6.
Alternative drugs, such as lamotrigine, baclofen, gabapentin, and pregabalin, may be used as second-line treatment or in combination with first-line drugs 4, 5.
Botulinum toxin A may be used as a presurgical option or in refractory cases 4, 5.
Surgical options, such as microvascular decompression, stereotactic radiation therapy, percutaneous balloon micro compression, percutaneous glycerol rhizolysis, and percutaneous radiofrequency, may be considered if pharmacological treatment fails 7.

The pharmacological treatment of trigeminal neuralgia typically involves the use of anticonvulsants, such as:

Carbamazepine: the gold standard of treatment for trigeminal neuralgia 4, 5, 6, 7, 8.
Oxcarbazepine: a first-line drug for the treatment of trigeminal neuralgia 4, 5.
Lamotrigine: a second-line drug for the treatment of trigeminal neuralgia 4, 5.
Baclofen: a second-line drug for the treatment of trigeminal neuralgia 4, 5.
Gabapentin: a second-line drug for the treatment of trigeminal neuralgia 4, 5.
Pregabalin: a second-line drug for the treatment of trigeminal neuralgia 4, 5.

Surgical options may be considered if pharmacological treatment fails, and include:

Microvascular decompression: a surgical procedure that involves relieving pressure on the trigeminal nerve 7.
Stereotactic radiation therapy: a non-invasive surgical procedure that uses radiation to relieve pressure on the trigeminal nerve 7.
Percutaneous balloon micro compression: a minimally invasive surgical procedure that involves compressing the trigeminal nerve to relieve pressure 7.
Percutaneous glycerol rhizolysis: a minimally invasive surgical procedure that involves injecting glycerol into the trigeminal nerve to relieve pressure 7.
Percutaneous radiofrequency: a minimally invasive surgical procedure that uses radiofrequency to relieve pressure on the trigeminal nerve 7.