This sounds horrible. I had heavy duty pain after a dental procedure three years ago. I had zero pain going into the procedure. It went from bad to worse. I too asked a dentist to pull the tooth, out of desperation. This did not help at all.

After trying many medications that either didn't work or had too many side effects, I ended up having a cream made especially for me that I rub on my jaw and ear area 3-4 x a day and the back of my neck 1x a day. In this cream is lidocaine, Capsaisin and Gabapentin. The cream is made by a compounding pharmacy and requires a doctor's prescription. Much less side effects using a cream like this...but this (a customized cream) is not available everywhere.

I also take certain tablets (pills) by mouth. One is Desipramine (most folks take Elavil) and I also take Baclofen. All of this has really helped me. (I'm taking five medications)

Very generally, the two or three meds that seem to help many folks with this type of situation are: Gabapentin, Elavil and Baclofen. I've seen these meds mentioned over and over again and folks getting varying degrees of pain relief. Some people do well on just one medication. It seems your brother has tried some of these..he might need a different dosage or various combinations of meds. Again, I take five medications for this pain.

There is a lidocaine applicator for inside the mouth called Kanka that is a little helpful. You can get it on amazon.

Good that he is taking these vitamins. I have found the B's (a good B multi plus extra B12 and magnesium possibly a little helpful, I'm not sure) I also did acupuncture, which helped a little...but ended up being expensive and only helped a very small amount.

I have known people who have attempted suicide from this pain. It is not to be taken lightly. If he is not getting better, he WILL need meds to help with pain relief ASAP.

I personally think time and medication has made my pain more controllable.

It might be a matter of trial and error with the meds, plus time.

Sending healing thoughts. Check out the TRigeminal Neuralgia site here for possibly more insight.