Trigeminal neuralgia (TN) has been referred to in the medical literature for centuries. Trigeminal neuralgia is the most common neurologic cause of facial pain. The first step is to make the correct diagnosis. Initial therapy should be low-dose carbamazepine, with upward titration of the dose to relief of pain. Baclofen is a good choice for second-line therapy. Most patients will respond to anticonvulsant therapy, but its effectiveness decreases with time. Newer medications have shown promise, but none has been shown to be more effective than carbamazepine and need not be used for firstline therapy. Effective surgical options are available for cases that do not respond to medical treatment. There are serious risks associated with the surgical procedures, which should be reserved for the most resistant cases of TN.

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