How do you manage acute exacerbations of trigeminal neuralgia?

I do not have personal experience treating TN exacerbations in the ED. What is generally recommended under those circumstances is intravenous phenytoin. Schnell et al. recently published it in The Journal of Headache and Face Pain (Schnell et al., PMID 32981076). They published the results of a retr...

• Auricotemporal Nerve Blocks and more
• Extra dose of medication patient is taking:
  • Baclofen
  • Diazepam
  • Nurtec off label use
  • Steroids Taper
• If there is high blood pressure, BP medication is given to reduce the pulse pressure of the vascular loop.

Two new studies out support the following treatments:

1. IV fosphenytoin
   Andersen et al., PMID 35469443
   
   
2. IV lacosamide or IV Phenytoin
   Muñoz-Vendrell et al., PMID 35469475