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. 2021 Jun 9;21(5):392–402. doi: 10.1136/practneurol-2020-002782

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© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Proposed algorithm for the treatment of trigeminal neuralgia. *Microvascular decompression (MVD) appears effective even in idiopathic TN and may be more effective than stereotactic radiosurgery. **If any of carbamazepine, oxcarbazepine, lamotrigine, gabapentin or pregabalin have not been tried then trials of these agents should be considered. ***Internal neurolysis is best avoided after MVD as there is a suggestion that there is a higher risk of anaesthesia dolorosa. ****Consider MVD if the secondary cause is optimally treated and there is evidence of neurovascular conflict; exercise caution in MS with ipsilateral pontine plaque. MS, multiple sclerosis; TN, trigeminal neuralgia.