Will Oxcarbazepine for trigeminal neuralgia mess up with the effect of Lamictal?

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 and last reviewed on: Sep 15, 2023

Hello doctor,

I have complicated migraines and simple partial seizures which are controlled by Lamictal. I have a long time of pain from sound intake and it has worsened in my face. Other sensory triggers the pain. It has become just way too much to handle. I sought advice from friends groups and nurses, who have trigeminal neuralgia and they suggested Carbamazepine. I learned it lowers Lamictal. I contacted the pharmacy that said many will test the 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 me to 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?



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 and 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, and chewing 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 an 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 take Oxcarbamazepine to avoid the 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 the Trigeminal nerve. Ultimately for TN, you can go for radiofrequency of the affected division of the Trigeminal nerve. Surgery is considered if there is a vascular loop.

I hope this helps.

Thank you.

Preventive measures:

Avoid exposure of face and ear to cold air. Wrap a scarf around the 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.

Hi doctor,

Thank you for your reply.

I never thought I could have TN. Even I do not have that sort of shock. It disappears in some time. I had hyperacusis with pain. Nerve pain that shoots down my face and jawline. It will occur in the middle of the face and forehead when triggered. All due to sensory input. There are two types of TN. Atypical and in constant pain. It is burning and stinging. I cannot watch TV, and I cannot use the computer as well. Hoping to get shots soon from a new neuro doctor. But thank you for this information. I will send this to my doctor.

Thank you.



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.

Thank you.

Hi doctor,

I have a sensory processing disorder (SPD) (sound, visual vertigo, and dull physical pain) from sound and other stimuli. A few years ago, my visual vertigo was present. But my mom wanted to see me, so I allowed her to. She hugged me so tight that she shook my neck and upper body. I instantly got sick. I ran to the bathroom and had nausea and disorientation. I went to bed and woke up sensitive to all movement. While sleeping in a bed, the mattress movement would cause shaking of my body and force me to sleep on the floor. The hard surface does not have motion. I became disoriented from turning in a shower, changing clothes, and bending my head and body movements.

Around this time, I would wake up with head pain until late afternoon. The scalp is sensitive to touch. I thought it was due to other things regarding my sensory processing disorder.

It was not until a recent trip to the hospital for an unrelated biopsy that forced into a car that bumped into the road. The car's movement shook me, even though I was medicated to lower my sensitivity to the world's senses. When I came home, the pain I had in my head. Painful scalp, sensitivity to body motion and moving. I could not take a shower due to the water against my scalp. The dizziness was not just disorientation, but like feeling the room was tilted or I was on an elevator, with any neck movement. The headphones I wear 24 hours from hyperacusis with pain now press against it. I switched to contact lenses.

My nurse sister mentioned cervical vertigo with occipital neuralgia. I had no idea I could get dizziness from my neck. I tried some massage in the occipital area and got immediate nausea and head sensations, flaring dizziness. I cannot touch it. I get some pain that feels like a fishing wire around my head. But the dizziness and nausea are the worst part. I started to read. I stopped wearing headphones in my sleep and got a new pillow. I have not been able to wash my hair yet, but if I do not touch it and do not move my head too much, I can manage.

Have you seen such motion sensitivity from the neck with ON?

I stopped the cervical dizziness but only for a short time. I started speaking with people with it; many have dizziness and nausea. I am working on getting in with a neurologist, but I would love any history you have seen with people and occipital problems.

Thank you.



Welcome back to icliniq.com.

Your symptoms could be due to occipital neuralgia. I would suggest you meet both a pain specialist and a neurologist. Occipital neuralgia may or may not be related to underlying cervical spondylosis or trapezius spasm. A diagnostic occipital nerve block is a simple bedside procedure that can be both diagnostic and therapeutic. If associated cervical spondylosis is present, cervical medial branch block and physiotherapy will help too.

All the best and take care.

Thank you.

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