ArticleHeadache
Second-line pharmacological treatment strategies for trigeminal neuralgia: A retrospective comparison of lacosamide, gabapentin and baclofen.
Article in Headache. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
5 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- HLA genotype testing for carbamazepine, oxcarbazepine and eslicarbazepine: A guideline developed by the UK Centre of Excellence in Regulatory Science and Innovation in Pharmacogenomics (CERSI-PGx).British journal of clinical pharmacology · 2026Guideline
- Slow-inactivated sodium channels as a therapeutic target in trigeminal neuralgia: evidence from a systematic review and meta-analysis of lacosamide.Journal of oral & facial pain and headache · 2026Pooled it
- Identifying predictors of neuropathic pain medication prescribing, adherence, and discontinuation: a systematic review and meta-analysis.British journal of anaesthesia · 2026Pooled it
- Emerging Pharmacological Strategies for Trigeminal Neuralgia.CNS drugs · 2026Review
- Article
Corrections and comments
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
objectivesCarbamazepine is commonly used as the first-line treatment for trigeminal neuralgia, but therapeutic failure due to adverse effects is frequent. While various second-line alternatives have been suggested, there is limited evidence directly comparing these options. This study aimed to evaluate and compare the effectiveness and tolerability of lacosamide, gabapentin, and baclofen in patients with refractory trigeminal neuralgia.
methodsThis retrospective cohort study analyzed patients with trigeminal neuralgia who, after not responding to carbamazepine, were treated with either lacosamide, gabapentin, or baclofen between January 2015 and December 2023. We collected clinical and demographic data and assessed response variables after 3 months of treatment. We compared pain relief (defined as patient-reported pain reduction and absence of additional treatments or emergency consultations within 3 months) and side effects. Secondary endpoints included absence of pain, treatment retention rates, and the need for subsequent surgery.
resultsA total of 49 patients were included, with 22 receiving lacosamide, 13 receiving gabapentin, and 14 receiving baclofen. The mean (standard deviation) age was 62.1 (14.1) years, with 53% female, and the median duration since diagnosis was 3.4 years. Carbamazepine failure was attributed to inefficacy in 76% of patients and intolerance in 24%. There were no significant demographic or clinical differences among the treatment groups, except for the concurrent use of carbamazepine: 68% in the lacosamide group, 54% in the gabapentin group, and 100% in the baclofen group (p = 0.019). Pain relief rates were 68% for lacosamide, 54% for gabapentin, and 64% for baclofen (p = 0.694). Adverse effects were reported in 46% of lacosamide, 31% of gabapentin, and 36% of baclofen users (p = 0.664). Complete pain relief was achieved in 36% with lacosamide, 53% with gabapentin, and 21% with baclofen (p = 0.218). The treatment discontinuation rates due to intolerance were 23% for lacosamide, 31% for gabapentin, and 21% for baclofen (p = 0.825).
conclusionLacosamide may be a viable second-line treatment option for refractory trigeminal neuralgia, showing comparable outcomes to gabapentin and baclofen.
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