Introduction
One of the challenges in primary care is the ongoing management of patients with chronic painful syndromes who have not responded to the standard treatment regimens. Polypharmacy, multiple speciality referrals, patient dissatisfaction, depression, frequent consultations and physician frustration often ensues [1]. Such conditions tend to have a high morbidity and low mortality. Trigeminal neuralgia is a typical example of such a condition. We present the case of a middle-aged woman who, despite neurosurgical decompressive surgery, radiofrequency ablation therapy, as well as multiple speciality referrals including dentistry and a specialist pain clinic review, continued to experience frequent, severe and disabling episodes of right-sided facial pain, attributed to trigeminal neuralgia. Her symptoms rapidly responded to a trial of oral sumatriptan 50 mg and are currently well controlled with intermittent sumatriptan and maintenance propranolol.

This case highlights a further possible treatment option for trigeminal neuralgia resistant to standard treatment options.