instruction: hello doctor I have complicated migraines simple partial seizures and are controlled by lamictal I have a long time pain from sound intake and it has worsened into my face other sensory triggers the pain it has become just way too much to handle I sought advice from friends and groups and nurses that have trigeminal neuralgia and they suggest carbamazepine I learned it lowers lamictal I contacted pharmacy that said many will test blood serum of lamictal and then add carbamazepine and adjust lamictal to therapeutic levels my doctor is a bit concerned she is not a pain doctor or neurologist I am waiting to see one but my condition makes it hard to travel in a car my doctor asked I seek advice do you agree that checking the serum and adjusting is fine to do in order to take carbamazepine the second option is oxcarbazepine in your experience is it a good pain drug for to and does it mess up lamictal I found a study that said it did not I was thinking I could start it now while I wait on lamictal levels and see if it helps just really struggling pain cream not helping much in certain places my old neurologist wanted me to lower glutamate as much as I could and suggested namenda at one point I know many people are on two and three drugs I hope to try injections for the pain soon do you have any suggestions
output: hello firstly we need to be sure if your pain is really trigeminal neuralgia to as there can be other causes of facial pain like idiopathic facial pain post herpetic neuralgia sometimes dental causes of facial pain can mic to trigeminal neuralgia has sharp shooting episodes of pain in any distribution of the trigeminal nerve pain is mostly along one side of pain and lasts for a few seconds pain can be triggered by brushing teeth cold air chewing of food mostly there is no baseline pain for to medications carbamazepine is the first line fda food and drug administration approved drug second line drugs are lamotrigine lamictal baclofen oxcarbamazepine phenytoin and gabapentin you are already on lamotrigine which is effective for to as add on medication you can do any of the following take carbamazepine and monitor serum levels of lamotrigine both combined will give good relief for to you can take oxcarbamazepine it does not interact with lamotrigine its effects are like carbamazepine I would suggest you to take oxcarbamazepine to avoid hassles of blood monitoring I have seen patients getting good relief with oxcarbamazepine remember that these medications take two to three weeks to show results and reach blood equilibrium most important is to confirm the diagnosis and then start the treatment you may require an mri brain to rule out any vascular loop pressing on trigeminal nerve ultimately for to you can go for radiofrequency of affected division of trigeminal nerve surgery is considered if there is a vascular loop I hope this helps avoid exposure of face and ear to cold air wrap a scarf around neck and face when exposed to environmental temperature avoid your trigger practice deep breathing sleep for seven to eight hours avoid swimming avoid smoking and alcohol