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Trigeminal neuralgia is multifactorial in etiology: it may be due to vascular compression, tumor, demyelination, or idiopathic causes. The treatment options are either medical (carbamazepine, oxacarbazepine, lamotrigine, neurontin, clonazepam, pregabalin, phenytoin, and baclofen) or surgical. Surgical management includes microsurgical exploration/decompression, percutaneous procedures (rhizotomies) on the Gasserian ganglion (radiofrequency lesioning, glycerol injection, and balloon compression), radiosurgery, and neurectomy. Bradycardia and even asystole as a result of the trigemino cardiac reflex can complicate this procedure. The noxious stimulus on the trigeminal nerve during needle insertion and balloon inflation is thought to induce the reflex. This reflex can also be activated without surgery; the mere pain of trigeminal neuralgia has reportedly resulted in bradycardia that was severe enough to cause syncope and in other instances degenerated to complete cardiac arrest. Events such as these demonstrate the potentially debilitating nature of trigeminal neuralgias.