I. Drug treatment. Primary trigeminal neuralgia is mainly treated with medication: carbamazepine, phenytoin sodium, etc., which must be taken under the guidance of a doctor’s hand and pay attention to toxic side effects. At the same time, it can be combined with the taking of Micropillar tablets, vitamin B12 and glutamate to improve the neurotrophic function. For the treatment of trigeminal neuralgia, the commonly used drugs are carbamazepine or phenytoin sodium, both of which need to be used separately and cannot be combined! And general anti-inflammatory and analgesic drugs are not effective. The two drugs should not be used separately! It has reliable efficacy in trigeminal neuralgia, but the disadvantage is that the duration of action is short and it often recurs after 24 hours of discontinuation, but it is still effective when repeated. The current scholarly recommendation is to start with a dose of 100 mg per day and gradually increase to 600 mg per day or more, but not more than 800 mg per day. The dose should be reduced after pain relief and maintained for at least 6 months. Phenytoin sodium: It is a first-generation broad-spectrum antiepileptic drug with some efficacy in trigeminal neuralgia, but it is not as reliable as carbamazepine, so it is not preferred. The recommended dose is 100 mg twice daily, which can be increased to 300-400 mg within 2-3 weeks. If there is no pain relief, the drug should be discontinued, and if relief is achieved, the dose should be gradually reduced and maintained for more than 6 months. Due to the side effects of carbamazepine and phenytoin sodium, the following two drugs can be used instead of carbamazepine. Deridol (imported carbamazepine tablets), start with 0.1g once, twice a day; after the second day, increase 0.1~0.2g every other day until the pain is relieved, and maintain 0.4~0.8g per day in divided doses; the maximum amount should not exceed 1.2g per day. mecobalamin tablets (methylcobalamin), 1500μg, taken orally, usually 1 tablet once, 3 times a day for adults. ②Oxcarbazepine (Tralee), dosage: The initial dose is 300mg/d, and the dose can be gradually increased to 900-3000mg/d to achieve satisfactory efficacy. Mecobal tablet (methylcobalamin), 1500μg, orally, usually 1 tablet once, 3 times a day for adults. Second, acupuncture, closure, radiofrequency treatment, peripheral avulsion therapy. Most cases relapse in about a year. The cost is about 500~3000 RMB. Third, microvascular decompression surgery treatment. Surgery has certain risks, but the procedure is the most effective treatment with the lowest recurrence rate. The cost is about $30,000. Microvascular decompression surgery: Under general anesthesia, a 4-cm incision is made behind the affected ear along the hairline, the skin and muscles are retracted to reveal the mastoid root, and a 1.5-cm diameter bone window is drilled. Under the operating microscope, the cerebrospinal fluid is slowly aspirated, the arachnoid is sharply cut, and the trigeminal nerve root is explored to find the responsible vessels (one or more) that are compressing the trigeminal nerve root, such as the anterior inferior cerebellar artery, posterior inferior cerebellar artery, and vertebral artery. The responsible vessel is freed by microdissection and then padded with tefflon to isolate the nerve from the vessel. The craniotomy is completed. The operating time is 2 to 3 hours. Postoperative admission to the neurosurgical ICU ward for 1~2 days. The stitches are removed and discharged from the hospital 5~7 days after surgery. Fourth, gamma knife treatment: for patients who have difficulty in tolerating surgery, advanced age, poor health condition, etc., gamma knife treatment can be chosen. The cost is about 30,000. The principle of Gamma Knife treatment for trigeminal neuralgia is: the use of γ-rays to irradiate the trigeminal nerve root or hemimelia, due to the nerve degeneration after γ-rays irradiation, it takes some time to appear, so the pain will not be eliminated immediately after γ-knife treatment, still need to continue to use painkillers, γ-knife after the onset of effect time is 2 days-7 months, the average of 3 months. On average, the pain is relieved or disappears in 80%-90% of cases within 3 months. Gamma Knife treatment for trigeminal neuralgia is suitable for: 1. those who are ineffective in medication or cannot tolerate the adverse effects of medication; 2. those who are ineffective in other methods or have recurrence; 3. those who are in poor physical condition or are old.