A lightning in the face

• The diagnosis of trigeminal neuralgia is clinical, and it is characterized by pain limited to the trigeminal territory, occurring in electric shock-like paroxysms and triggered by innocuous cutaneous stimulation or maneuvers. • In newly diagnosed trigeminal neuralgia, an MRI scan or complete trigeminal reflex testing is mandatory to exclude major neurological diseases. • First-line therapy is medical and includes carbamazepine or oxcarbazepine. If the occurrence of side effects prevents the patient from reaching the effective dosage, a neurosurgical referral should be considered.