Role of the neurologist in the evaluation and treatment of patients with trigeminal neuralgia.

The neurologist, although not usually the first healthcare provider to evaluate a patient with trigeminal neuralgia (TN), is often involved in confirming the diagnosis and managing the patient's pain with medications. The neurologist has several other important roles for patients with TN: assessing and reducing the individual's pain, patient and family education, and encouraging referral to a neurosurgeon for pain-reducing procedures when appropriate. In general, surgical procedures for TN should be considered when the patient does not attain pain relief after adequate trials of two or three medications, or when pain relief is attained but the patient requires medication dosing at levels that result in significant drug toxicity. There is emerging evidence that surgical procedures for TN are more effective if performed earlier in the course of the patient's pain.