Management of Trigeminal Neuralgia using Amitriptyline and Pregablin combination Therapy

Abstract

Trigeminal neuralgia (TN) is a clinical condition presenting with severe, paroxysmal facial pain, often described by patients also known as tic douloureux. Carbamazepine (CBZ) is the drug of choice, but some patients develop adverse effects and some others may become unresponsive to CBZ. We present three cases of TN which were unresponsive to CBZ but successfully managed with a pregabalin and amitriptyline combination therapy. Although, these drugs have been used individually to treat TN, we combined the two drugs using relatively low doses. All three cases remain pain free after follow up periods of 12, 10 and 16 months. Although, more cases are needed to be followed up on long term to ascertain the long term prognosis of patients on this combination, we recommend this Pregabalin/ amitriptyline combination especially for cases that are resistant or intolerant to carbamazepine.

Keywords: Trigeminal Neuralgia, management, amitriptyline, pregabalin.