Topic: Trigeminal Neuralgia
Subject: Medicine
A man complains that recently when he shaves he has a shooting type of pain in his face. It happens once in a while and then goes away. You suspect trigeminal neuralgia.
What is the treatment of choice?

Trigeminal neuralgia is severe paroxysmal facial pain due to a disorder of the 5th cranial nerve. Pain occurs along the distribution of one or more sensory divisions of the trigeminal nerve, most often the maxillary. The pain is paroxysmal, lasting seconds up to 2 min, but attacks may recur rapidly. It is lancinating, excruciating, and sometimes incapacitating. Pain is often precipitated by stimulating a facial trigger point (eg, by chewing, brushing the teeth, or smiling). Sleeping on that side of the face is often intolerable. Diagnosis is clinical. Treatment is usually with carbamazepine or gabapentin; sometimes surgery is required.