26th June 2023

A 35-year-old lady presents with a 1-week history of severe debilitating electrical shooting pains on the right side of her face

A 35-year-old lady presents with a 1-week history of severe debilitating electrical shooting pains on the right side of her face, each episode lasting seconds, with sometimes up to 10 episodes a day. Episodes tend to be spaced out throughout the day and seem to happen when she has anything hot to drink, leading to her having to suffer drinking cold tea. She is usually fit and well and has been trying to conceive. She has tried paracetamol and ibuprofen analgesia to no effect. She has no associated tearing or rhinorrhoea during attacks. A neurological examination finds no obvious focal neurology.

Given the likely diagnosis, which is the most appropriate initial treatment option?