Severe Facial Pain in the Emergency Department

Abstract The chapter “Severe Facial Pain in the Emergency Department” examines the diagnosis, evaluation, and management of trigeminal neuralgia. Trigeminal neuralgia is an extremely painful condition involving repetitive, triggered, electrical shock–like pain on one side of the face. The diagnosis is made based on history and examination. However, imaging is needed to identify either vascular compression of the nerve or a secondary cause of trigeminal neuralgia. Preferred imaging is an MRI with gadolinium and thin cuts through the posterior fossa. First-line treatment for trigeminal neuralgia is carbamazepine or oxcarbazepine. If these medications are not effective or not tolerated, it is reasonable to consult neurosurgery for procedural options while trying a second-line pharmacologic option.