Medication for trigeminal neuralgia type 1 is usually prescribed during the episodes of symptoms. Most patients will take these medications life-long. We usually prefer to give people “drug holidays”, which is where the drug will be stopped if their symptoms go away in the hopes that they don’t develop a tolerance to the drug. The natural history or the natural progression of this condition, however, is that we find the drugs become less and less effective over time. We need higher and higher doses, which is why many patients after several years of having this condition do ultimately need some sort of intervention, whether it’s radiation, a needle procedure, or brain surgery.