A retrospective review of efficacy of combination therapy with pregabalin and carbamazepine versus pregabalin and amitriptyline in treatment of trigeminal neuralgia

Aims: Trigeminal neuralgia is a rare cause of neuropathic pain and carbamazepine [CBZ] is its main treatment. However, its adverse effects sometimes compel the physicians to substitute or use it concurrently with other drugs. This study aimed to retrospectively compare the effects of combination therapy with pregabalin and carbamazepine versus pregabalin and amitriptyline, in the treatment of patients with refractory trigeminal neuralgia. Methodology: Hospital records of 37 patients with refractory trigeminal neuralgiaandno favorable response to the primary treatment without pregabalin, were retrospectively reviewed. Demographic information, drug doses and response to the treatment were recorded in a proforma. Visual Analogue Scale [VAS] was used as the tool for measuring pain intensity. Pain reduction equal or less than 50% based on VAS score after eight weeks of treatment was defined as no response to therapy, and pain reduction of more than 50% was considered as positive response. Results: Twenty eight patients received pregabalin and carbamazepine, three patients received combination of pregabalin and amitriptyline and six received pregabalin, carbamazepine and amitriptyline combination. The mean dose of pregabalin and carbamazepine was 125.68 +/- 63.87 and 283.78 +/- 193.66 mg/day, respectively. After 8 weeks of treatment, 18 patients [64.3%] in pregabalin and carbamazepine group, six patients [100%] in triple therapy group and two cases [66.7%] in pregabalin and amitriptyline group had responded to treatment. Conclusion: The effect of combination therapy with pregabalin and carbamazepine was comparable with pregabalin and amitriptyline. Using these combinations may be beneficial in patients with severe trigeminal neuralgia unresponsive to primary treatment

Nonsurgical treatment of stylohyoid (Eagle) syndrome: a case report

Eagle syndrome is a rare condition caused by elongation of the styloid process or calcification of the stylohyoid ligament. Patients with Eagle syndrome typically present with dysphagia, dysphonia, cough, voice changes, otalgia, sore throat, facial pain, foreign body sensation, headache, vertigo, and neck pain. Here we report a case in which the patient initially presented with sore throat, left-sided facial pain, and cough. This case report provides a brief review of the diagnosis and nonsurgical management of this rare syndrome.