17th August 2023

A 65-year-old man presents to the neurology clinic with a history of sharp, shooting facial pain in the distribution of the left V2 and V3 trigeminal nerve branches

A 65-year-old man presents to the neurology clinic with a history of sharp, shooting facial pain in the distribution of the left V2 and V3 trigeminal nerve branches. The pain is severe and comes on suddenly, lasting for a few seconds before resolving. His GP has started him on carbamazepine with some relief, but he is experiencing unpleasant side effects.

What would be the most appropriate next step in management?