AAN-EFNS guidelines on trigeminal neuralgia management

G. Cruccu, G. Gronseth, J. Alksne, C. Argoff, M. Brainin, K. Burchiel, T. Nurmikko, J. M. Zakrzewska

Research output: Contribution to journalReview articlepeer-review

474 Scopus citations


Several issues regarding diagnosis, pharmacological treatment, and surgical treatment of trigeminal neuralgia (TN) are still unsettled. The American Academy of Neurology and the European Federation of Neurological Societies launched a joint Task Force to prepare general guidelines for the management of this condition. After systematic review of the literature the Task Force came to a series of evidence-based recommendations. In patients with TN MRI may be considered to identify patients with structural causes. The presence of trigeminal sensory deficits, bilateral involvement, and abnormal trigeminal reflexes should be considered useful to disclose symptomatic TN, whereas younger age of onset, involvement of the first division, unresponsiveness to treatment and abnormal trigeminal evoked potentials are not useful in distinguishing symptomatic from classic TN. Carbamazepine (stronger evidence) or oxcarbazepine (better tolerability) should be offered as first-line treatment for pain control. For patients with TN refractory to medical therapy early surgical therapy may be considered. Gasserian ganglion percutaneous techniques, gamma knife and microvascular decompression may be considered. Microvascular decompression may be considered over other surgical techniques to provide the longest duration of pain freedom. The role of surgery versus pharmacotherapy in the management of TN in patients with multiple sclerosis remains uncertain.

Original languageEnglish (US)
Pages (from-to)1013-1028
Number of pages16
JournalEuropean Journal of Neurology
Issue number10
StatePublished - Oct 2008


  • Antiepileptic drugs
  • Diagnosis
  • Gamma knife
  • Gasserian ganglion surgery
  • MRI
  • Microvascular decompression
  • Neurovascular contact
  • Treatment
  • Trigeminal neuralgia
  • Trigeminal reflex

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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