A Lightning in the Face

Abstract This chapter presents the case of an old woman who suffers from facial pain characterized by intense attacks, limited to the right side of the face, involving the cheek, upper and lower lips, and the underlying gums, lasting fractions of a seconds, and sometimes occurring in bursts. Her clinical picture is typical of trigeminal neuralgia. Diagnosis is clinical, but a magnetic resonance imaging scan or complete trigeminal reflex testing is mandatory to exclude major neurological diseases. First-line therapy is medical and includes carbamazepine or oxcarbazepine. If the occurrence of side effects prevents the patient from reaching the effective dosage, a neurosurgical referral should be considered.