Almost all patients with trigeminal neuralgia are first treated with medication. The medication of choice is carbamazepine (Tegretol). Very commonly, patients are started on a dose that is too high and that can produce significant side effects, like drowsiness, mental slowness, and imbalance. The key is to start at a low dose. I usually recommend 100mg twice a day. That dose will usually lead to rapid relief (within 24 hours) of trigeminal neuralgia, with minimal or no side effects. Over time, many patients have to gradually increase the dose to provide pain relief. As long as this is done slowly, side effects will be rare. Tegretol blood levels are NOT a useful guide when using the drug for facial pain. Routine blood tests are NOT necessary unless you start to feel unwell. In such cases, your doctor will check your blood chemistry, blood counts, and liver function as they can, rarely, be affected by this drug. Tegretol has been used for decades in large numbers of patients with epilepsy, as well as facial pain. It is safer than surgery. Surgery is reserved for those cases where medication fails to control pain or causes intolerable side effects.