Trigeminal neuralgia is the most common disease in pain medicine. The disease is characterized by sudden onset, abrupt stopping, lightning-like, knife-like, burning, intractable and severe pain in the area of distribution of the trigeminal nerve in the head and face. The pain can be severe when speaking, washing the face, brushing the teeth or breezing, or even when walking. The pain lasts for a few seconds or minutes, with periodic episodes of pain, and intervals between attacks are the same as normal. Trigeminal neuralgia mostly occurs in middle-aged and elderly people. Primary trigeminal neuralgia: the etiology is unknown and may be related to vascular compression, tooth extraction infection, and central action. Secondary trigeminal neuralgia: it is related to skull base tumor compression and nerve demyelination lesion. Treatment: I. Drug therapy is the preferred method for patients with primary trigeminal neuralgia. 1.Anti-epileptic drugs Carbamazepine: the drug of choice for the treatment of trigeminal neuralgia, usage: it is advisable to take it after meals, usually starting from l00mg twice a day, and then increasing l00mg daily until the pain is relieved or disappears, with this effective amount for 2-3 weeks, and then gradually reduce to find out the minimum effective amount (100mg/time, 3 times a day), and then take this maintenance amount for several months. The side effects may include drowsiness, dizziness, drug rash, digestive disorders, diplopia, ataxia, etc., which can generally disappear after reducing the dosage or stopping the drug. However, bone marrow suppression and hepatic impairment may occur with long-term use, which should be observed. Oxcarbazepine is a new drug of the second generation. Phenytoin sodium: its therapeutic effect is not as good as carbamazepine, usage: the initial dose of 0.19, 3 times a day, and then increase 0.lg daily until the pain stops (or to 0.2g, 3 times a day), continue to apply for 2-3 weeks, and then (or when symptoms of poisoning appear) gradually reduce the dose, but also should be maintained in the minimum effective amount for several months after the cessation of pain. The main side effects are ataxia (dizziness, unsteady gait, etc.), visual impairment, gingival hyperplasia, and leukopenia. Gabapentin: The starting dose of gabapentin is 300mg/d, and then gradually increase until the pain is controlled, the general dosage is 1200mg/d, the maximum can be 2400mg/d. 2, anti-spasticity drugs: Baclofen is a muscle relaxant and anti-spasticity drugs, currently there are two commercial drugs in the domestic market, namely Chiropractic and Lioresal. 3.Vitamins: In order to promote nerve repair, B vitamins can be given. Nerve block treatment Injecting anti-inflammatory and nerve-nourishing drugs into trigeminal nerve or trunk or branch is safe, effective and easy to operate, and is suitable for mild trigeminal neuralgia with drug intolerance. Local botulinum toxin injection treatment uses the principle of botulinum toxin to inhibit the release of various transmitters that sensitize pain receptors (such as substance P and calcitonin gene-related peptide). It is suitable for local pain with spasm. Disadvantages: it inevitably causes facial paralysis and other symptoms, the analgesic range is not perfect, and the analgesic effect is generally maintained for no more than 3 months. Gamma knife treatment High-dose gamma radiation irradiates the nociceptive conduction nerve of trigeminal nerve root, blocking the nociceptive conduction pathway. It is non-invasive and does not require hospitalization. Disadvantages: operation is not easy to locate, there is a risk of injury to adjacent nerves at the base of the skull, higher cost, may leave facial numbness, abnormal sensation, etc., the cure rate is limited, easy to relapse. V. Radiofrequency thermal coagulation treatment Through high-frequency current to produce gradual warming, acting on the ganglion, so that the nerve degeneration necrosis, blocking nerve conduction. It has the characteristics of safety, simplicity, controllability, long analgesic action, repeatability and low cost, especially suitable for patients who cannot or refuse open surgery due to their advanced age. Disadvantages: postoperative with local numbness, abnormal sensation, masticatory muscle weakness, etc., can gradually heal on its own. Sixth, microvascular decompression is a craniotomy to isolate the responsible blood vessel compressing the nerve root from the trigeminal nerve root with a foreign body to treat trigeminal neuralgia. It is suitable for patients with obvious vascular compression as shown by MRI; middle-aged and young patients as well as patients with good general physical condition; patients with chronic diseases such as diabetes and heart disease are not suitable for surgery. Disadvantages: traumatic, some patients have the risk of facial numbness, facial paralysis, intracranial hemorrhage, intracranial infection, and even death. Some patients have recurrence, and repeat treatment is not possible due to the damage caused to the trigeminal nerve by craniotomy.