Question

A 55-year-old woman with unilateral intermittent lancinating facial pain radiating to the jaw presents to your clinic for pain management. Which medication is the most appropriate first-line therapy?

A. Gabapentin
B. Carbamazepine
C. Hydrocodone
D. Amitriptyline
E. Oxcarbazepine 210

Answer 1

Carbamazepine is the most appropriate first-line therapy for trigeminal neuralgia, being effective in reducing nerve pain. Gabapentin or its prodrug gabapentin enacarbil are alternatives, especially if carbamazepine is not tolerated well.

Step-by-step explanation:

The appropriate first-line therapy for a 55-year-old woman presenting with unilateral intermittent lancinating facial pain radiating to the jaw, suggestive of trigeminal neuralgia, is B. Carbamazepine. This medication is considered the gold standard for initial treatment of this condition due to its efficacy in reducing nerve pain. Gabapentin or its prodrug gabapentin enacarbil can be considered as alternative options, particularly in patients who do not tolerate carbamazepine well. Hydrocodone, an opioid, might be used for severe acute pain but is not ideal for long-term management of trigeminal neuralgia due to the risk of dependence and side effects. Amitriptyline, a tricyclic antidepressant, and oxcarbazepine are other options but are generally not considered first-line.