A 72-year-old woman with bipolar disorder visited our department with a complaining of a persistent stinging pain in the right cheek, as well as a stabbing pain in the right cheek and maxilla when brushing her teeth or drinking water. We diagnosed her as having right trigeminal neuralgia and immediately began administration of 300 mg/day carbamazepine. Because of similarities between the patient's psychiatric symptoms and the side effects of the antinociceptive drugs used to treat trigeminal neuralgia, selecting appropriate drugs or determineing their efficacy was difficult. Although the patient had strong resistance to and mental rejection of trigeminal nerve block, considering it a last-treatment option, she eventually consented to undergo alcohol nerve block, which improved her symptoms significantly.
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