Q. How does Lamictal interfere with Carbamazepine for migraine pain?

Answered by
Dr. Poonam Patel Vasani
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Mar 22, 2020

Hello doctor,

I have complicated migraines, simple partial seizures and are controlled by Lamictal. I have a long time pain from sound intake and it has worsened into my face. Other sensory triggers the pain. It has become just way too much to handle. I sought advice from friends and groups and nurses, that have trigeminal neuralgia and they suggest Carbamazepine.

I learned it lowers Lamictal. I contacted pharmacy that said many will test blood serum of Lamictal and then add Carbamazepine and adjust Lamictal to therapeutic levels.

My doctor is a bit concerned. She is not a pain doctor or neurologist. I am waiting to see one. But my condition makes it hard to travel in a car. My doctor asked I seek advice. Do you agree that checking the serum and adjusting is fine to do, in order to take Carbamazepine?

The second option is Oxcarbazepine. In your experience is it a good pain drug for TN and does it mess up Lamictal? I found a study that said it did not.

I was thinking I could start it now while I wait on Lamictal levels. And see if it helps. Just really struggling. Pain cream not helping much in certain places. My old neurologist wanted me to lower Glutamate as much as I could and suggested Namenda at one point. I know many people are on two and three drugs. I hope to try injections for the pain soon. Do you have any suggestions?

#

Hello,

Welcome to icliniq.com.

Firstly, we need to be sure if your pain is really Trigeminal neuralgia (TN) as there can be other causes of facial pain like idiopathic facial pain, Post-herpetic neuralgia. Sometimes dental causes of facial pain can mimic TN.

Trigeminal neuralgia has sharp, shooting episodes of pain in any distribution of the trigeminal nerve. Pain is mostly along one side of pain and lasts for a few seconds. Pain can be triggered by brushing teeth, cold air, chewing of food. Mostly there is no baseline pain.

For TN medications, Carbamazepine is the first line FDA (food and drug administration) approved drug.

Second line drugs are Lamotrigine (Lamictal), Baclofen, Oxcarbamazepine, Phenytoin, and Gabapentin. You are already on Lamotrigine which is effective for TN.

As add on medication you can do any of the following:

1. Take Carbamazepine and monitor serum levels of Lamotrigine. Both combined will give good relief for TN.

2. You can take Oxcarbamazepine. It does not interact with Lamotrigine. Its effects are like Carbamazepine. I would suggest you to take Oxcarbamazepine to avoid hassles of blood monitoring. I have seen patients getting good relief with Oxcarbamazepine.

Remember that these medications take two to three weeks to show results and reach blood equilibrium. Most important is to confirm the diagnosis and then start the treatment. You may require an MRI brain to rule out any vascular loop pressing on Trigeminal nerve.

Ultimately for TN, you can go for radiofrequency of affected division of Trigeminal nerve. Surgery is considered if there is a vascular loop.

I hope this helps.


Preventive measures:

Avoid exposure of face and ear to cold air. Wrap a scarf around neck and face when exposed to environmental temperature. Avoid your trigger. Practice deep breathing. Sleep for seven to eight hours. Avoid swimming. Avoid smoking and alcohol.

Thank you doctor,

I never thought I could have TN given I do not have that sort shock or stab and then it goes a way. I had hyperacusis with pain. Nerve pain that shoots down my face and jaw line. When bad it will occur in middle of the face and forehead. All due to sensory input. And someone said well, there is type 2 of TN. Atypical and is constant pain, that is basically me. Burning, stinging, cannot watch TV, and cannot use computer as well. Hoping to get shots soon from a new neuro doctor. But thank you for this info I will send this to my doctor.

#

Hello,

Welcome back to icliniq.com.

The main treatment will be determined by diagnosis. So definitely a detailed clinical assessment is the key. Also, consult a pain specialist. Interventional pain management will give you a good quality of life with such terrible pain.

All the best and live pain-free.


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