A 26-year-old man presents with a stabbing, severe pain in the left side of his face for the past 2 weeks. The pain is described as a “stabbing knife” sensation and occurs about every 12 to 15 minutes. It lasts for about 4 to 5 seconds. The pain is so unbearable that the patient cannot sleep or function in his employment as an accountant. The patient has tried aspirin and acetaminophen to no avail. Physical examination is unremarkable, but the patient has one of the attacks during the visit and visibly shows excruciating pain.
Which of the following is the treatment of choice for this patient’s condition?
A. SumatriptanCarbamazepine. This patient is presenting with signs and symptoms consistent with a diagnosis of trigeminal neuralgia, a neuropathic disorder characterized by episodes of intensely severe pain in the face that originates from the trigeminal nerve. The drug of choice for trigeminal neuralgia is carbamazepine, an anticonvulsant that stabilizes the inactivated state of voltage-gated sodium channels. The drug is effective in the majority of patients with trigeminal neuralgia; however, one of the rare side effects is aplastic anemia so routine complete blood count (CBC) is necessary with these patients. If carbamazepine fails to alleviate the pain, surgery through decompression or partial resection of the trigeminal nerve is the next best option. (A) Sumatriptan is used in acute migraine attacks and cluster headaches. (B) Acyclovir is used in the treatment of herpes zoster and herpetic neuralgia. However, this presents with pain and a vesicular rash in a dermatomal distribution. (C) Morphine is a narcotic agent used to control pain in several disorders. It has not been shown to be of benefit in patients suffering from trigeminal neuralgia.