What is the correct answer?


Topic: Trigeminal Neuralgia
Subject: Medicine
A 55-year-old man complains of extremely severe, sharp, shooting pain in his face. He describes the episodes as being like a bolt of electricity that are brought about by touching a specific area, last about 60 seconds, and occur many times during the day. Neurologic examination is completely normal, but it is noted that part of his face is unshaven because he fears to touch that area. Gadoliniumenhanced MRI shows no abnormalities of the trigeminal nerve.
Which of the following is the most appropriate initial treatment?

A. Anticonvulsants

B. Aspirin

C. Nonsteroidal anti-inflammatory drugs

D. Vasoconstrictors

Correct Answer :

A. Anticonvulsants

The clinical description is that of trigeminal neuralgia (tic douloureux), which is treated with anticonvulsants. Carbamazepine is usually the first choice, but phenytoin has also been used. Antidepressants, such as amitriptyline, have also been tried. Surgical decompression of the nerve or stereotactic ablation are used in recalcitrant cases.

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