It should now be possible, in almost all cases, to relieve the pain of patients who have trigeminal neuralgia (tic douloureux). Given a series of medical and surgical observations made over the last decade, a patient with this disease can be encouraged that specific forms of treatment exist that should produce pain remission, either permanent or at least semipermanent. Therapy may employ either medical or surgical expertise, usually both. Thus, cooperation between physician and surgeon in the management of trigeminal neuralgia is mandatory.
Most authorities agree that medical treatment is indicated first, if for no other reason than its use constitutes a therapeutic challenge to the diagnosis. If a patient presumed to have trigeminal neuralgia does not respond rapidly to carbamazepine in 24 to 48 hours, for example, then the diagnosis is seriously in doubt. After all, the diagnosis is made on the basis of history alone, and some patients
Donald J. Dalessio. Treatment of Trigeminal Neuralgia. JAMA. 1981;245(24):2519–2520. doi:10.1001/jama.1981.03310490037024