First-line treatment for trigeminal neuralgia in primary care is carbamazepine. This is the recommended initial pharmacological therapy due to its established efficacy in controlling the characteristic paroxysmal facial pain of trigeminal neuralgia. Carbamazepine should be prescribed following MHRA safety advice, particularly regarding use in pregnancy and monitoring for adverse effects.
If carbamazepine is not effective, not tolerated, or contraindicated, early referral to a specialist pain service or a condition-specific service is advised for further management and consideration of alternative treatments.
While other neuropathic pain treatments such as amitriptyline, duloxetine, gabapentin, or pregabalin are offered for neuropathic pain generally, these are not first-line for trigeminal neuralgia in primary care.
Recent clinical trial designs, such as the phase IIa study evaluating CNV1014802, indicate ongoing research into novel agents for trigeminal neuralgia, but these are not yet established first-line options in primary care.
Key References
- CG173 - Neuropathic pain in adults: pharmacological management in non-specialist settings
- NG193 - Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain
- CG150 - Headaches in over 12s: diagnosis and management
- (Zakrzewska et al., 2013): Novel design for a phase IIa placebo-controlled, double-blind randomized withdrawal study to evaluate the safety and efficacy of CNV1014802 in patients with trigeminal neuralgia.